Healthcare Provider Details

I. General information

NPI: 1750921250
Provider Name (Legal Business Name): MARJORIE PLOEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 13TH AVE SOUTH
SAINT JAMES MN
56081
US

IV. Provider business mailing address

1105 13TH AVE SOUTH
SAINT JAMES MN
56081
US

V. Phone/Fax

Practice location:
  • Phone: 507-375-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number121906
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: