Healthcare Provider Details

I. General information

NPI: 1083518153
Provider Name (Legal Business Name): PAUL ROBERT KROGH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 46TH AVE S
MINNEAPOLIS MN
55406-3604
US

IV. Provider business mailing address

3944 46TH AVE S
MINNEAPOLIS MN
55406-3604
US

V. Phone/Fax

Practice location:
  • Phone: 612-251-4784
  • Fax:
Mailing address:
  • Phone: 612-251-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117991
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: