MEDICARE: DEANNE MARIE ANDERSON 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	114273	MN

General Provider Information

NPI Number	:	1851730113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNE MARIE ANDERSON RPH

Provider Business Mailing Address
First Line	:	PO BOX 359
Second Line	:	2040 SECOND ST
City	:	LAKE PARK
State	:	MN
Zip	:	56554
Country	:	US
Telephone Number	:	218-238-6642
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 SECOND ST
Second Line	:
City	:	LAKE PARK
State	:	MN
Zip	:	56554
Country	:	US
Telephone Number	:	218-238-6642
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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