Healthcare Provider Details

I. General information

NPI: 1427988039
Provider Name (Legal Business Name): ALYSSA O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA KLANCHER

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 GRAND AVE
DULUTH MN
55807-2754
US

IV. Provider business mailing address

4498 UGSTAD RD UNIT 531
HERMANTOWN MN
55811-6601
US

V. Phone/Fax

Practice location:
  • Phone: 218-628-2897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127001
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: