Healthcare Provider Details

I. General information

NPI: 1710840061
Provider Name (Legal Business Name): ALLYSON MARIE CONGER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 POLK ST NE
MINNEAPOLIS MN
55418-1323
US

IV. Provider business mailing address

3518 POLK ST NE
MINNEAPOLIS MN
55418-1323
US

V. Phone/Fax

Practice location:
  • Phone: 218-966-9413
  • Fax:
Mailing address:
  • Phone: 218-966-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127206
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: