Healthcare Provider Details

I. General information

NPI: 1497420970
Provider Name (Legal Business Name): DEANDRA LUNDEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

907 TAFT ST S
CAMBRIDGE MN
55008-9314
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number125343
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: