GERITOM MED INC (NPI# 1285621193) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285621193 |
| Entity Type | Organization |
| Organization Name | GERITOM MED INC |
| Other Organization Name | GERITOM MED INC |
| Practice Address |
10501 Florida Ave S Bloomington MN 55438-2553 |
| Practice Telephone | 9528541190 |
| Practice Fax Number | 9528541082 |
| Mailing Telephone | 9528541190 |
| Mailing Fax Number | 9528541082 |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2020-09-16 |
| Authorized Official Name | DR. JASON RYAN WACHTL (VICE PRESIDENT) |
| Authorized Official Telephone | 9528541190 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
261375 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 718560000 | 05 | |
| PK | 2046914 | 01 |
| Other Name | Type Code |
|---|---|
| GERITOM MED INC | Doing Business As Name - Organization |
| Street Address |
10501 FLORIDA AVE S |
| City | BLOOMINGTON |
| State | MN |
| Zip Code | 55438-2553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144769118 | Clarice Olson | Pharmacist | 10501 Florida Ave S, Bloomington, MN 55438-2553 | 2017-02-23 |
| 1467991422 | Jon Evenson | Pharmacist | 10501 Florida Ave S, Bloomington, MN 55438-2553 | 2017-02-22 |
| 1962941906 | John Stites | Pharmacist | 10501 Florida Ave S, Bloomington, MN 55438-2553 | 2017-02-22 |
| 1689113623 | Laura L Mahlendorf | Pharmacist | 10501 Florida Ave S, Bloomington, MN 55438-2553 | 2017-02-22 |
| 1073993622 | Jacqueline Larson | Pharmacist | 10501 Florida Ave S, Bloomington, MN 55438-2553 | 2015-06-08 |
| 1245672740 | Brittany Kantar | Pharmacist | 10501 Florida Ave S, Bloomington, MN 55438-2553 | 2013-07-24 |
| 1558507558 | Jason Ryan Wachtl | Pharmacist | 10501 Florida Ave S, Bloomington, MN 55438-2553 | 2008-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912425570 | Angela Marie Gilbert | Registered Nurse | 10700 Brunswick Rd Unit 316, Bloomington, MN 55438 | 2017-09-05 |
| 1609905686 | Marypat Habermas | Pharmacist | 7349 Bush Lake Dr, Bloomington, MN 55438 | 2007-03-05 |
| 1629564620 | Andrea Jean Hegland | Pharmacist | One Veterans Drive, Pharmacy Service (119), Minneapolis, MN 55438 | 2018-07-03 |
| 1861050197 | Dustin James Javers | Physical Therapist | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2019-06-01 |
| 1285156240 | Dawn Marie Johnson | Occupational Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2017-07-12 |
| 1154777654 | Jennifer Bean | Occupational Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2016-05-13 |
| 1831588250 | Sia Bacas Langum | Occupational Therapist | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2015-01-22 |
| 1073948576 | Kathleen Ann Linnan Rudgers | Physical Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2013-09-04 |
| 1508201211 | Barbara Ann Spleiss | Occupational Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2013-05-08 |
| 1194160895 | Patty Norby | Physical Therapist | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2013-05-08 |
| Find all providers in zip 55438 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1215237359 | Axline Advanced | Pharmacy | 1210 Towanda Ave, Unit 10, Bloomington, IL 61701-3454 | 2010-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
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| 1629613005 | Lotus Ltc Pharmacy, LLC | Pharmacy | 9850 51st Ave N Ste 102, Plymouth, MN 55442-3271 | 2019-11-09 |
| 1720541337 | Ltc Prescription Providers #2 | Pharmacy | 220 1/2 Third Avenue, Proctor, MN 55810 | 2019-04-10 |
| 1639634710 | Lewis Family Drug, LLC | Pharmacy | 1105 13th Ave S, Saint James, MN 56081 | 2019-02-04 |
| 1033680046 | Brainerd Medical Center Inc | Pharmacy | 280 Barclay Ave W, Ste 1100, Pine River, MN 56474 | 2018-12-17 |
| 1457832909 | Black Forest Pharmacy Services Ltd | Pharmacy | 108 S 6th St Ste 1, Brainerd, MN 56401-3594 | 2018-08-23 |
| 1467932905 | Watertown Pharmacy LLC | Pharmacy | 204 Lewis Ave S Ste 101, Watertown, MN 55388-4501 | 2018-08-15 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1346757457 | Twin Valley Pharmacy LLC | Pharmacy | 108 Viking Ave W., Ulen, MN 56585 | 2018-01-10 |
| Find all providers with the same taxonomy | ||||
| City | BLOOMINGTON |
| Zip Code | 55438 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.