Healthcare Provider Details

I. General information

NPI: 1265439418
Provider Name (Legal Business Name): AMANDA R BRUMMEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 EXCELSIOR BLVD SUITE 275
MINNEAPOLIS MN
55416-4688
US

IV. Provider business mailing address

2650 MAJOR AVE N
GOLDEN VALLEY MN
55422-3651
US

V. Phone/Fax

Practice location:
  • Phone: 612-827-4751
  • Fax:
Mailing address:
  • Phone: 763-588-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116813-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: