Healthcare Provider Details

I. General information

NPI: 1629303417
Provider Name (Legal Business Name): MARIT BJORDAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GOLF COURSE RD
GRAND RAPIDS MN
55744-8648
US

IV. Provider business mailing address

1601 GOLF COURSE RD
GRAND RAPIDS MN
55744-8648
US

V. Phone/Fax

Practice location:
  • Phone: 218-999-1881
  • Fax:
Mailing address:
  • Phone: 218-999-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number122717
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: