Healthcare Provider Details

I. General information

NPI: 1417672429
Provider Name (Legal Business Name): EILEEN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15034 SHANNON PKWY
ROSEMOUNT MN
55068-1795
US

IV. Provider business mailing address

15034 SHANNON PKWY
ROSEMOUNT MN
55068-1795
US

V. Phone/Fax

Practice location:
  • Phone: 651-322-6603
  • Fax: 651-322-6608
Mailing address:
  • Phone: 651-322-6603
  • Fax: 651-322-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125815
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: