Healthcare Provider Details

I. General information

NPI: 1003101460
Provider Name (Legal Business Name): CYNTHIA GELLNER PHARM D
Entity Type: Individual
Gender: Female
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

8225 FLYING CLOUD DR T0220
EDEN PRAIRIE MN
55344-5315
US

IV. Provider business mailing address

8225 FLYING CLOUD DR T0220
EDEN PRAIRIE MN
55344-5315
US

V. Phone/Fax

Practice location:
  • Phone: 952-944-8720
  • Fax: 952-944-8720
Mailing address:
  • Phone: 952-944-8720
  • Fax: 952-944-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116920
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: