Healthcare Provider Details

I. General information

NPI: 1851983449
Provider Name (Legal Business Name): CHAD DARIN GEDNALSKE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WABASHA ST S STE 100
SAINT PAUL MN
55107-1819
US

IV. Provider business mailing address

130 WABASHA ST S STE 100
SAINT PAUL MN
55107-1819
US

V. Phone/Fax

Practice location:
  • Phone: 651-829-2240
  • Fax: 651-829-2250
Mailing address:
  • Phone: 651-829-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number63957
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number116032
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: