PARK NICOLLET HEALTH CARE PRODUCTS (NPI# 1295961597) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295961597 |
| Entity Type | Organization |
| Organization Name | PARK NICOLLET HEALTH CARE PRODUCTS |
| Practice Address |
9555 Upland Ln N Maple Grove MN 55369 |
| Mailing Address |
Po Box 1309 Minneapolis MN 55440-1309 |
| Practice Telephone | 9529932200 |
| Practice Fax Number | 9529932206 |
| Mailing Telephone | 9529933804 |
| Mailing Fax Number | 9529676667 |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2018-06-06 |
| Authorized Official Name | DAVID BUSCH (VICE PRESIDENT, PHARMACY OPERATIONS) |
| Authorized Official Telephone | 9529675049 |
| Is Organization Subpart | Y |
| Parent Organization Name | PARK NICOLLET PHARMACY |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
263381 | MN | Suppliers |
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2120606 | 01 | |
| MN | 1295961597 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376048728 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 921 Greeley St S # 19101a, Stillwater, MN 55082-5935 | 2018-03-28 |
| 1780103408 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 400 Wabasha Street Suite 260, St. Paul, MN 55102-1109 | 2017-09-13 |
| 1346598810 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 13688 Rogers Drive, Rogers, MN 55374-4916 | 2012-08-15 |
| 1235695594 | Park Nicollet Health Care Products | Eyewear Supplier (Equipment, not the service) | 8401 Golden Valley Rd, Golden Valley, MN 55427-4486 | 2019-02-12 |
| 1003311457 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 1500 Curve Crest Blvd W, Stillwater, MN 55082-6040 | 2018-03-28 |
| 1487159836 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 927 Churchill St W, Stillwater, MN 55082-6605 | 2018-03-28 |
| 1881100089 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 700 5th St S, Hopkins, MN 55343-7764 | 2017-12-26 |
| 1114438546 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 411 Stageline Rd, Hudson, WI 54016-7848 | 2017-10-12 |
| 1144749862 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 155 Radio Drive, Woodbury, MN 55125-2040 | 2017-09-13 |
| 1629597331 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 535 Hospital Rd, New Richmond, WI 54017-1449 | 2017-09-13 |
| Street Address |
9555 UPLAND LN N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568453926 | David C Sandell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2005-11-03 |
| 1114528593 | Dana Marie Feia | Physician Assistant | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-11-03 |
| 1235741364 | Relevium Chiropractic Care Pa | Chiropractor | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-08-19 |
| 1467012872 | Bethany Wysocki | Audiologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2019-06-18 |
| 1487168357 | Dusty Renee Hackler | Psychologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-11-29 |
| 1841722469 | Brynne Rainier Wilson Latterell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-04-02 |
| 1982150728 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 66369 | 2016-08-31 |
| 1528514932 | David Chollar | Social Worker | 9555 Upland Ln N, Behavioral Health, 3rd Floor, Maple Grove, MN 55369-4485 | 2016-08-27 |
| 1770037574 | Biye Tambang | Nurse Practitioner | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-08-09 |
| 1174975528 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083138317 | Fairview Pharmacy Services LLC | Pharmacy | 17 Exchange St W Ste 150, Saint Paul, MN 55102-1045 | 2017-07-28 |
| 1760792691 | Goodrich Pharmacy Fridley | Pharmacy | 480 Osborne Rd Suite 180, Fridley, MN 55432 | 2010-10-13 |
| 1770719585 | Fairview Pharmacy Services LLC | Pharmacy | 14712 Victor Hugo Blvd N Ste 10, Hugo, MN 55038-6324 | 2009-06-08 |
| 1548400849 | Moka Pharmacy Inc | Pharmacy | 1515 E Franklin Ave, Minneapolis, MN 55404-2137 | 2009-02-26 |
| 1902012107 | Metro Treatment of Minnesota, Lp | Pharmacy | 14 E Central Entrance, Suite B, Duluth, MN 55811-5508 | 2007-05-15 |
| 1790909083 | Aitkin Community Hospital Inc. | Pharmacy | 27278 State Hwy 18, Garrison, MN 56450 | 2007-04-11 |
| 1437203882 | Shakopee Mdewakanton Sioux Comm Phcy | Pharmacy | 15045 Mystic Lake Dr Nw, Prior Lake, MN 55372-9011 | 2007-01-23 |
| 1407931553 | Waconia Pharmacy | Pharmacy | 430 Highway 5 West, Waconia, MN 55387-1795 | 2006-10-26 |
| 1548365406 | Mayo Foundation for Medical Education & Research | Pharmacy | 201 Center St W, Ste Lo92, Rochester, MN 55902-3003 | 2006-09-14 |
| 1407951353 | Mayo Foundation for Medical Education & Research | Pharmacy | 221 4th Ave Sw Ste 1116, Rochester, MN 55902-3110 | 2006-09-14 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
Please comment or provide details below to improve the information on PARK NICOLLET HEALTH CARE PRODUCTS.
| 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.