Active NPI
David John Light, RPH
- Pharmacist
- Waite Park, MN
National Provider Identifier
1962771642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 112825
- Practice address
- 17 Division St
Waite Park, MN 56387-1349 - Phone
- (320) 203-1035
- NPI assigned
- Dec 24, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 112825 | MN | Primary |
Addresses
Primary practice location
17 Division St
Waite Park, MN 56387-1349
Mailing address
6483 36TH Ave SE
Saint Cloud, MN 56304-9409
Phone (320) 656-5830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112825 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324684800000",
"number": "1962771642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6483 36TH AVE SE",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563049409",
"telephone_number": "320-656-5830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 DIVISION ST",
"city": "WAITE PARK",
"state": "MN",
"postal_code": "563871349",
"telephone_number": "320-203-1035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHT",
"first_name": "DAVID",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-24",
"last_updated": "2011-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "112825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waite Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.