Healthcare Provider Details

I. General information

NPI: 1194640367
Provider Name (Legal Business Name): DAWN DALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 W 78TH ST
MINNEAPOLIS MN
55439-2649
US

IV. Provider business mailing address

1662 OAKBROOKE CIR
EAGAN MN
55122-4212
US

V. Phone/Fax

Practice location:
  • Phone: 651-428-2839
  • Fax:
Mailing address:
  • Phone: 651-428-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115981
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: