Healthcare Provider Details

I. General information

NPI: 1295703379
Provider Name (Legal Business Name): SHANNON ROSE CORRIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7806 COUNTY ROAD 47
SAINT CLOUD MN
56301-9738
US

IV. Provider business mailing address

7806 COUNTY ROAD 47
SAINT CLOUD MN
56301-9738
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-3571
  • Fax:
Mailing address:
  • Phone: 320-253-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113642-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: