Healthcare Provider Details

I. General information

NPI: 1770725582
Provider Name (Legal Business Name): BEN EARL ANDERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 TRETTEL LANE FOND DU LAC HUMAN SERVICES DIVISION
CLOQUET MN
55720-8247
US

IV. Provider business mailing address

927 TRETTEL LANE FOND DU LAC HUMAN SERVICES DIVISION
CLOQUET MN
55720-8247
US

V. Phone/Fax

Practice location:
  • Phone: 218-878-2185
  • Fax: 218-878-3755
Mailing address:
  • Phone: 218-878-2185
  • Fax: 218-878-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117495
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: