CENTRACARE PHARMACY SERVICES LLC (NPI# 1013966175) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013966175 |
| Entity Type | Organization |
| Organization Name | CENTRACARE PHARMACY SERVICES LLC |
| Other Organization Name | CENTRACARE PHARMACY HEALTH PLAZA |
| Practice Address |
1900 Centracare Circle Suite 1350 St Cloud MN 56303 |
| Practice Telephone | 3202294904 |
| Practice Fax Number | 3202295168 |
| Mailing Telephone | 3202294904 |
| Mailing Fax Number | 3202295168 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2019-06-25 |
| Authorized Official Name | MR. KURT T OTTO (VICE PRESIDENT) |
| Authorized Official Telephone | 3202512700 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTRACARE HOLDINGS, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
2620682 | MN | Suppliers |
| Y | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP | 2424543 | 01 | |
| MN | 05092Y800 | 05 |
| Other Name | Type Code |
|---|---|
| CentraCare Pharmacy Health Plaza | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386600641 | Centracare Pharmacy Services LLC | Pharmacy | 1555 Northway Dr Ste 150, Saint Cloud, MN 56303-4912 | 2006-04-25 |
| 1093771818 | Centracare Pharmacy Services LLC | Pharmacy | 1406 Sixth Avenue North, St Cloud, MN 56303 | 2006-04-21 |
| 1578128021 | Centracare Pharmacy Services LLC | Pharmacy | 1900 Centracare Circle, Suite 1849, St. Cloud, MN 56303 | 2019-05-09 |
| Street Address |
1900 CENTRACARE CIRCLE SUITE 1350 |
| City | ST CLOUD |
| State | MN |
| Zip Code | 56303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003815051 | Jennifer J Rogan | Pediatrics | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2005-07-20 |
| 1659694628 | Bethany T. Dingmann | Dietitian, Registered | 1900 Centracare Circle, Suite 2500, St Cloud, MN 56303-5000 | 2010-03-05 |
| 1073708608 | Rachel Wenner Ruzanic | Dermatology | 1900 Centracare Circle, Centracare Clinic- Health Plaza Specialties, St Cloud, MN 56303-5000 | 2007-09-06 |
| 1982737938 | Daniel W Kraft | Internal Medicine | 1900 Centracare Circle, Centracare Clinic Health Plaza Gastroenterology, St Cloud, MN 56303 | 2007-03-13 |
| 1154466209 | Robin C Marushin | Obstetrics & Gynecology | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2007-02-20 |
| 1124173919 | David M Pence | Radiology | 1900 Centracare Circle, St Cloud, MN 56303 | 2007-01-24 |
| 1659425114 | Centracare Clinic | Durable Medical Equipment & Medical Supplies | 1900 Centracare Circle, Centracare Clinic Internal Medicine, St Cloud, MN 56303 | 2007-01-22 |
| 1720155336 | Nelson L Adamson | Radiology | 1900 Centracare Circle, Centracare Clinic Health Plaza Specialties, St Cloud, MN 56303-5000 | 2006-11-29 |
| 1588734214 | Erin Y Scapanski | Physician Assistant | 1900 Centracare Circle, Centracare Clinic, St Cloud, MN 56303 | 2006-11-09 |
| 1639248065 | Donna F Johnson | Psychologist | 1900 Centracare Circle, Centracare Health Plaza, St Cloud, MN 56303 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 3336S0011X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Specialty Pharmacy |
| A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration. |
| 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 |
|---|---|---|---|---|
| 1386158418 | Fairview Pharmacy Services, LLC | Pharmacy | 1527 London Rd, Duluth, MN 55812-1617 | 2017-11-28 |
| 1023563731 | Palubicki's Inc. | Pharmacy | 300 1st Street West, Fosston, MN 56542-1224 | 2016-08-23 |
| 1447632096 | Ltcarerx Consulting LLC | Pharmacy | 15430 Frances Ln Nw, Miltona, MN 56354-8320 | 2015-06-19 |
| 1578128021 | Centracare Pharmacy Services LLC | Pharmacy | 1900 Centracare Circle, Suite 1849, St. Cloud, MN 56303 | 2019-05-09 |
| 1477867380 | Option Care Enterprises, Inc. | Pharmacy | 1000 S Benton Dr, Suite 405, Sauk Rapids, MN 56379-1227 | 2010-08-03 |
| 1659609972 | Children's Health Care | Pharmacy | 2530 Chicago Avenue South, 220, Minneapolis, MN 55404-4289 | 2009-11-24 |
| 1942264270 | Allina Health System | Pharmacy | 333 Smith Ave N, Saint Paul, MN 55102-2344 | 2006-04-13 |
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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.