Healthcare Provider Details

I. General information

NPI: 1699637496
Provider Name (Legal Business Name): TRICIA HAGEDORN PHARMD, BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NORTH AVE
NORTHFIELD MN
55057-1697
US

IV. Provider business mailing address

2000 NORTH AVE
NORTHFIELD MN
55057-1697
US

V. Phone/Fax

Practice location:
  • Phone: 507-646-1168
  • Fax: 507-646-1169
Mailing address:
  • Phone: 507-646-1168
  • Fax: 507-646-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number117511
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: