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>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1003323965

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1620 S CEDAR AVE  OWATONNA, MN 55060-3922 US
Tel: 507-451-0179  Fax: --

Contact information for business:
2425 CORNELL DR  FARIBAULT, MN 55021-3431 US
Tel: 563-380-9173  Fax: --

Registration Information:
NPI: 1003323965
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers

Legacy codes, insurance codes and state license numbers:




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