Healthcare Provider Details

I. General information

NPI: 1588390074
Provider Name (Legal Business Name): ANN MARIE DONOVAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MAIN ST SW
PRESTON MN
55965
US

IV. Provider business mailing address

103 SPRUCE ST SE
FOUNTAIN MN
55935-8825
US

V. Phone/Fax

Practice location:
  • Phone: 507-765-2156
  • Fax: 507-765-2115
Mailing address:
  • Phone: 507-251-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1165445
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: