KELLY J MARR (NPI# 1831749530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831749530 |
| Entity Type | Individual |
| Full Name | KELLY J MARR |
| Credential | PHARMD |
| Practice Address |
200 12th St Sw Forest Lake MN 55025-1482 |
| Practice Telephone | 6514649742 |
| Practice Fax Number | 6514649725 |
| Mailing Telephone | 6514649742 |
| Mailing Fax Number | 6514649725 |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2019-09-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 117254 | MN | Pharmacy Service Providers |
| Street Address |
200 12TH ST SW |
| City | FOREST LAKE |
| State | MN |
| Zip Code | 55025-1482 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801813290 | Walmart Inc. | Pharmacy | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2006-07-16 |
| 1952909905 | Ashley Louise Augustine | Pharmacist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2020-10-13 |
| 1649878612 | Laura Marie Olson | Pharmacist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2020-10-13 |
| 1912115999 | Dr Richard D Bruesch, Pa | Optometrist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2007-05-21 |
| 1255412243 | Wal-mart Stores, Inc. | Technician/Technologist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2006-10-18 |
| 1922119486 | Richard David Bruesch | Optometrist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2006-08-31 |
| 1003922030 | Roy William Backus | Optometrist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2006-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043846173 | Persistence Physical Therapy LLC | Clinic/Center | 2009 W Broadway Ave, Ste 400 Pmb 131, Forest Lake, MN 55025 | 2020-03-20 |
| 1255973319 | Connie Rettig | Technician | 908 North Shore Drive, Forest Lake, MN 55025 | 2019-10-10 |
| 1003394479 | Malissa Ann Costanzo | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 844 8th Ave Se, Forest Lake, MN 55025 | 2018-07-30 |
| 1669754735 | Brent Alan Millard | Pharmacist | 1207 West Broadway Ave, Forest Lake, MN 55025 | 2011-09-15 |
| 1982842167 | Lakes Center for Youth and Families | Community/Behavioral Health | 20 N Lake Street, Suite 103, Forest Lake, MN 55025 | 2009-01-27 |
| 1487843355 | Paul Luke Mladnick | Marriage & Family Therapist | 1068 So Lake St, #109, Forest Lake, MN 55025 | 2007-10-17 |
| 1740477678 | Rita Lynn Scanlan | Occupational Therapist | 604 Ne 1st St, Birchwood Health Care Center, Forest Lake, MN 55025 | 2007-09-25 |
| 1114053113 | Senior Care Forest Lake, LLC | Skilled Nursing Facility | 604 N.e. First Street, Forest Lake, MN 55025 | 2007-02-26 |
| 1073672101 | Catharine B Ruther | Dentist | 956 West Broadway, Lakes Dental Clinic, Forest Lake, MN 55025 | 2006-12-06 |
| 1407914849 | Ervin George Savord | Dentist | 255 Highway 97, Suite 1b, Forest Lake, MN 55025 | 2006-12-05 |
| Find all providers in zip 55025 | ||||
| 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 |
|---|---|---|---|---|
| 1841819786 | Thomas Haas IIi | Pharmacist | 107 Lake St N # 55334, Forest Lake, MN 55025-2594 | 2020-04-10 |
| 1356614119 | Raymond Keith Vellenga | Pharmacist | 7617 172nd Ave Ne, Forest Lake, MN 55025-8873 | 2012-02-09 |
| 1669754735 | Brent Alan Millard | Pharmacist | 1207 West Broadway Ave, Forest Lake, MN 55025 | 2011-09-15 |
| 1568754745 | Brian J Arnold | Pharmacist | 4934 200th St N, Forest Lake, MN 55025-8062 | 2011-05-06 |
| 1952909905 | Ashley Louise Augustine | Pharmacist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2020-10-13 |
| 1649878612 | Laura Marie Olson | Pharmacist | 200 12th St Sw, Forest Lake, MN 55025-1482 | 2020-10-13 |
| 1033592019 | Nathan Bahr | Pharmacist | 1207 W Broadway Ave, Forest Lake, MN 55025-1418 | 2015-07-08 |
| 1942642715 | Heather Dekan | Pharmacist | 356 12th St Sw, Forest Lake, MN 55025-1749 | 2013-07-22 |
| 1609216019 | Dan John Hagen | Pharmacist | 808 Lake St S, Forest Lake, MN 55025-2614 | 2013-06-29 |
| 1629355409 | Chestevia Gibson | Pharmacist | 1207 W Broadway Ave, Forest Lake, MN 55025-1418 | 2011-11-08 |
| Find all providers in FOREST LAKE | ||||
| City | FOREST LAKE |
| Zip Code | 55025 |
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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.