Healthcare Provider Details

I. General information

NPI: 1033108386
Provider Name (Legal Business Name): LAURA J SCHWARTZWALD R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S 6TH ST
BRAINERD MN
56401-3575
US

IV. Provider business mailing address

26235 RABBIT TRL
AITKIN MN
56431-3172
US

V. Phone/Fax

Practice location:
  • Phone: 218-829-0347
  • Fax:
Mailing address:
  • Phone: 218-546-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115121-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: