Healthcare Provider Details

I. General information

NPI: 1992906853
Provider Name (Legal Business Name): KRISTIN J SOMSKY R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 W BROADWAY AVE
FOREST LAKE MN
55025-9373
US

IV. Provider business mailing address

5490 157TH ST N
HUGO MN
55038-8794
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-4603
  • Fax: 651-982-4626
Mailing address:
  • Phone: 651-653-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116438
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: