Healthcare Provider Details

I. General information

NPI: 1821728221
Provider Name (Legal Business Name): PATRICK SEAN MCDONOUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 2ND AVE NW
KASSON MN
55944-4002
US

IV. Provider business mailing address

19 2ND AVE NW
KASSON MN
55944-4002
US

V. Phone/Fax

Practice location:
  • Phone: 507-634-3341
  • Fax: 507-634-4067
Mailing address:
  • Phone: 507-634-3341
  • Fax: 507-634-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116257
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: