Healthcare Provider Details

I. General information

NPI: 1851990071
Provider Name (Legal Business Name): CRISTINA INEZ MCLEAN GUIMARAES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTINA INEZ MCLEAN GUIMARAES PHARMD

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 06/11/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 S POKEGAMA AVE
GRAND RAPIDS MN
55744-2507
US

IV. Provider business mailing address

42760 HOSPITAL DRIVE RED LAKE INDIAN HEALTH SERVICE
REDLAKE MN
56671
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-7020
  • Fax:
Mailing address:
  • Phone: 218-766-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number124805
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number124805
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: