Healthcare Provider Details

I. General information

NPI: 1851930192
Provider Name (Legal Business Name): PAKOU REMICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

853 96TH AVE NE
BLAINE MN
55434-2553
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6210
  • Fax:
Mailing address:
  • Phone: 651-968-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number124638
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: