Healthcare Provider Details

I. General information

NPI: 1346168275
Provider Name (Legal Business Name): MARY VUE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

4668 381ST TRL
NORTH BRANCH MN
55056-5142
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-2040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number126925
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: