Healthcare Provider Details

I. General information

NPI: 1720614969
Provider Name (Legal Business Name): MARA PLIFKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 87TH ST NE
OTSEGO MN
55330-6546
US

IV. Provider business mailing address

14474 GENESEE AVE
APPLE VALLEY MN
55124-8417
US

V. Phone/Fax

Practice location:
  • Phone: 763-252-1316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number123962
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: