Healthcare Provider Details

I. General information

NPI: 1770965196
Provider Name (Legal Business Name): MONICA KOWALKE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BABCOCK BLVD E
DELANO MN
55328-2811
US

IV. Provider business mailing address

2791 50TH ST NE
BUFFALO MN
55313-3642
US

V. Phone/Fax

Practice location:
  • Phone: 763-972-8385
  • Fax: 763-972-8391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number120565
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: