Healthcare Provider Details

I. General information

NPI: 1497667976
Provider Name (Legal Business Name): HAILEY ROSE BEMBOOM PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAILEY ROSE LARSON

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR STE 150
SAINT CLOUD MN
56303-4912
US

IV. Provider business mailing address

1615 15TH AVE SE APT 236
SAINT CLOUD MN
56304-2396
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-2700
  • Fax:
Mailing address:
  • Phone: 254-640-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127547
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: