Healthcare Provider Details

I. General information

NPI: 1043908528
Provider Name (Legal Business Name): ANNA ZHUSHMA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E TRAVELERS TRL
BURNSVILLE MN
55337-2885
US

IV. Provider business mailing address

300 E TRAVELERS TRL
BURNSVILLE MN
55337-2885
US

V. Phone/Fax

Practice location:
  • Phone: 952-894-9040
  • Fax:
Mailing address:
  • Phone: 612-223-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125952
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: