Healthcare Provider Details

I. General information

NPI: 1306843792
Provider Name (Legal Business Name): MARK TRUMM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FILLMORE ST
ALEXANDRIA MN
56308-1706
US

IV. Provider business mailing address

600 FILLMORE ST
ALEXANDRIA MN
56308-1706
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-3111
  • Fax: 320-763-7289
Mailing address:
  • Phone: 320-763-3111
  • Fax: 320-763-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113351-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: