Healthcare Provider Details

I. General information

NPI: 1922771294
Provider Name (Legal Business Name): PETER ZQ CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HILLIGOSS BLVD SE
FOSSTON MN
56542-1542
US

IV. Provider business mailing address

900 HILLIGOSS BLVD SE
FOSSTON MN
56542-1542
US

V. Phone/Fax

Practice location:
  • Phone: 218-435-7688
  • Fax: 218-435-6572
Mailing address:
  • Phone: 218-435-7688
  • Fax: 218-435-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125267
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: