Healthcare Provider Details

I. General information

NPI: 1568303618
Provider Name (Legal Business Name): KATHERINE ANICESCU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE OLSON

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HARVARD ST SE
MINNEAPOLIS MN
55455-0353
US

IV. Provider business mailing address

2700 UNIVERSITY AVE W APT 415
SAINT PAUL MN
55114-2027
US

V. Phone/Fax

Practice location:
  • Phone: 612-453-9422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number814808
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: