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NPI Code Detail

MEDICARE: CATHERINE WAIN

MEDICARE: CATHERINE WAIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist118436MN

General Provider Information

NPI Number : 1114449477
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE WAIN
Provider Business Mailing Address
First Line : 19130 LAKE AVE
Second Line :
City : WAYZATA
State : MN
Zip : 55391-3066
Country : US
Telephone Number : 612-386-6237
Fax Number :
Provider Business Practice Location Address
First Line : 4656 EXCELSIOR BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-4938
Country : US
Telephone Number : 952-929-0140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2017
Last Update Date : 07/07/2017

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Directions to “ CATHERINE WAIN ” Practice Location

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