MARK BOUDREAU (NPI# 1558996884) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558996884 |
| Entity Type | Individual |
| Full Name | MARK BOUDREAU |
| Credential | PHARMD |
| Practice Address |
3913 W Old Shakopee Rd Bloomington MN 55437-2944 |
| Practice Telephone | 9522521062 |
| Mailing Telephone | 9522521062 |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-03-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 19470-40 | WI | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659834323 | Mark Ricard Boudreau Jr. | Pediatrics | 744 1st St, Macon, GA 31201-6840 | 2019-04-10 |
| Street Address |
3913 W OLD SHAKOPEE RD |
| City | BLOOMINGTON |
| State | MN |
| Zip Code | 55437-2944 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841424926 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3913 W Old Shakopee Rd, Bloomington, MN 55437-2944 | 2009-05-05 |
| 1104438639 | Brianna Gunderson | Pharmacist | 3913 W Old Shakopee Rd, Bloomington, MN 55437-2944 | 2020-08-17 |
| 1225314974 | Kristin Jeffrey Slocum | Pharmacist | 3913 W Old Shakopee Rd, Bloomington, MN 55437-2944 | 2011-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710344494 | Bloomington Smiles Dentistry, PC | Dentist | 10700 France Avenue, Suite 102, Bloomington, MN 55437 | 2016-01-26 |
| 1851788988 | Rachael Anne Wilson | Dentist | 4200 West Old Shakopee Rd, Suite 100, Bloomington, MN 55437 | 2015-04-15 |
| 1518166891 | Ronald Lawrence Shapiro | Internal Medicine | 5270 W 84th St, #500, Minneapolis, MN 55437 | 2007-07-16 |
| 1275742900 | Riverview Spine, P.a. | Chiropractor | 5402 W. Old Shakopee Road, Bloomington, MN 55437 | 2007-05-21 |
| 1184846149 | Michael Robert Wiles | Chiropractor | 5017 West 106th Street, Bloomington, MN 55437 | 2007-05-02 |
| 1821181421 | Tms Treatment Center Inc | Community Based Residential Treatment Facility, Mental Illness | 5414 West Old Shakopee Circle, Bloomington, MN 55437 | 2006-10-02 |
| 1952493736 | The James Inc | Home Health | 4533 Normandale Highlands Drive, Bloomington, MN 55437 | 2006-09-29 |
| 1093747354 | Kris J Kalenda | Dentist | 4200 W Old Shakopee Rd, Suite 221, Bloomington, MN 55437 | 2006-07-07 |
| 1871560078 | Gregory Borg Hanson | Dentist | 5270 W 84 St, Bloomington, MN 55437 | 2006-03-07 |
| 1770076184 | Cal Leonard Johnson | Physical Therapist | 5001 American Blvd W Ste 945, Bloomington, MN 55437 | 2018-06-11 |
| Find all providers in zip 55437 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558980813 | Ambika Soni | Pharmacist | 2103 N Veterans Pkwy Unit 3, Bloomington, IL 61704-0908 | 2020-04-15 |
| 1548805104 | Jasjeet Singh Waraitch | Pharmacist | 2650 S Walnut St, Bloomington, IN 47401-7302 | 2019-11-07 |
| 1740791250 | Sara Vande Walle | Pharmacist | 8400 Normandale Lake Blvd Ste 700, Bloomington, MN 55437-3810 | 2017-10-24 |
| 1487171682 | Brenden James King | Pharmacist | 645 S Rogers St Ste C, Bloomington, IN 47403-2353 | 2017-08-28 |
| 1356897391 | Brittany Ann Oliver | Pharmacist | 800 N Smith Rd, Apt G11, Bloomington, IN 47408-2928 | 2016-08-30 |
| 1073987152 | Christopher Bennett | Pharmacist | 48 Pebblebrook Ct, Bloomington, IL 61705-6300 | 2015-11-30 |
| 1912374505 | Alphonsus M Brady | Pharmacist | 2510 E Washington St, Apt #13, Bloomington, IL 61704-4447 | 2015-08-31 |
| 1376928853 | Cory Patterson | Pharmacist | 2104 Hackberry Rd, Bloomington, IL 61704-2788 | 2015-07-24 |
| 1689062671 | Lester Burris II | Pharmacist | 2424 S Walnut St, Bloomington, IN 47401-7730 | 2014-12-30 |
| 1053718510 | Dhaval H Patel | Pharmacist | 2001 S Morris Ave, 16, Bloomington, IL 61704-7293 | 2014-11-28 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 55437 |
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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.