Healthcare Provider Details

I. General information

NPI: 1699116038
Provider Name (Legal Business Name): ASHLEY ANNE GELLNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 VINEWOOD LN N
PLYMOUTH MN
55442-2624
US

IV. Provider business mailing address

16653 50TH CT N
PLYMOUTH MN
55446-4531
US

V. Phone/Fax

Practice location:
  • Phone: 763-553-0302
  • Fax:
Mailing address:
  • Phone: 701-371-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number121261
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: