Kelly Marie Dethloff, PHARMD.

Primary specialty

PharmacistTaxonomy code 183500000X

License

118343 Issued in MN

Practice address

901 9TH St N
Virginia, MN 55792-2325

Phone

(218) 749-9441

Fax

(218) 749-9565

NPI assigned

Jan 24, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Marie Urick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358985600000",
    "number": "1982942025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 9TH ST N",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922325",
            "telephone_number": "218-749-9441",
            "fax_number": "218-749-9565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 9TH ST N",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922325",
            "telephone_number": "218-749-9441",
            "fax_number": "218-749-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETHLOFF",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "PHARMD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2013-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "118343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "URICK",
            "middle_name": "MARIE",
            "credential": "PHARMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pharmacist in Virginia, MN
• Providers in Virginia, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.