Healthcare Provider Details

I. General information

NPI: 1720132392
Provider Name (Legal Business Name): MICHAEL JOHN HORN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

3059 AVALON COVE CT NW
ROCHESTER MN
55901-8497
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2021
  • Fax:
Mailing address:
  • Phone: 612-508-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118320
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: