MEDICARE: MR. DARREN LEE GOLDEN RPH

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
1	183500000X	Pharmacist	115846	MN

General Provider Information

NPI Number	:	1366787590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARREN LEE GOLDEN RPH

Provider Business Mailing Address
First Line	:	25090 STUMVOLL LN
Second Line	:
City	:	NISSWA
State	:	MN
Zip	:	56468-2923
Country	:	US
Telephone Number	:	218-821-1834
Fax Number	:

Provider Business Practice Location Address
First Line	:	30503 STATE HWY 371
Second Line	:
City	:	PEQUOT LAKES
State	:	MN
Zip	:	56472-2913
Country	:	US
Telephone Number	:	218-568-5884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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