Healthcare Provider Details

I. General information

NPI: 1548696370
Provider Name (Legal Business Name): CHRISTOPHER DORNACK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 LONE STONE CT SE
CHATFIELD MN
55923-3218
US

IV. Provider business mailing address

1302 LONE STONE CT SE
CHATFIELD MN
55923-3218
US

V. Phone/Fax

Practice location:
  • Phone: 507-251-3844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117501
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: