Active NPI
Russell Devolder
- Pharmacist
- Cass Lake, MN
National Provider Identifier
1972817013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 21224
- Practice address
- 425 7TH St NW
Cass Lake, MN 56633-3360 - Phone
- (218) 335-3267
- NPI assigned
- Jul 30, 2010
- Last updated
- Jul 30, 2010
- 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 | 21224 | IA | Primary |
Addresses
Primary practice location
425 7TH St NW
Cass Lake, MN 56633-3360
Mailing address
PO Box 540
Cass Lake, MN 56633-0540
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21224 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280448000000",
"number": "1972817013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 540",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "566330540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 7TH ST NW",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "566333360",
"telephone_number": "218-335-3267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVOLDER",
"first_name": "RUSSELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-30",
"last_updated": "2010-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "21224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cass Lake, MN
- Department of Health & Human Services PHS IHS (Cass Lake Indian Health Service)
- Department of Health & Human Services PHS IHS
- Department of Human Services & PHS, IHS
- Department of Human Services &PHS, IHS
- Tamra Rae Devault
- Whitney Dickson, PHARMD
- Ann Marie Dietman, LICSW
- Diane Dietman, LPN
- Cynthia Ann Doke, RN
- Mark A Ellis, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.