Healthcare Provider Details

I. General information

NPI: 1275836710
Provider Name (Legal Business Name): LOWELL JOHN ANDERSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HARVARD ST SE 7-172 WEAVER-DENSFORD HALL
MINNEAPOLIS MN
55455-0353
US

IV. Provider business mailing address

308 HARVARD ST SE 7-172 WEAVER-DENSFORD HALL
MINNEAPOLIS MN
55455-0353
US

V. Phone/Fax

Practice location:
  • Phone: 612-622-5158
  • Fax:
Mailing address:
  • Phone: 612-622-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number110462
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: