Healthcare Provider Details

I. General information

NPI: 1932019437
Provider Name (Legal Business Name): RACHAEL LICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6386 MINERAL PT
LINO LAKES MN
55038-4600
US

IV. Provider business mailing address

6386 MINERAL PT
LINO LAKES MN
55038-4600
US

V. Phone/Fax

Practice location:
  • Phone: 612-708-2413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number117498
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: