Healthcare Provider Details

I. General information

NPI: 1366737736
Provider Name (Legal Business Name): CORWIN GELLNER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 W 78TH ST T-0862
CHANHASSEN MN
55317-9579
US

IV. Provider business mailing address

851 W 78TH ST T-0862
CHANHASSEN MN
55317-9579
US

V. Phone/Fax

Practice location:
  • Phone: 952-470-1006
  • Fax: 952-277-1006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116766
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: