Healthcare Provider Details

I. General information

NPI: 1487665253
Provider Name (Legal Business Name): PATRICK JAMES GASTONGUAY MSPHARM, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR VA MEDICAL CENTER PHARMACY SERVICE (119)
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

628 E 134TH ST
BURNSVILLE MN
55337-4140
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4173
  • Fax: 612-970-5893
Mailing address:
  • Phone: 952-894-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3329
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: