Healthcare Provider Details

I. General information

NPI: 1851508626
Provider Name (Legal Business Name): JAMES MARK HALVORSEN RPH, BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FAIRVIEW BLVD
RED WING MN
55066-2848
US

IV. Provider business mailing address

2034 LAUNA AVE
RED WING MN
55066-3823
US

V. Phone/Fax

Practice location:
  • Phone: 651-267-5260
  • Fax: 651-267-5936
Mailing address:
  • Phone: 651-388-5850
  • Fax: 651-267-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number111959
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number111959
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: