Healthcare Provider Details

I. General information

NPI: 1043223779
Provider Name (Legal Business Name): RYAN D LUNDELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. CLOUD VETERANS AFFAIRS MEDICAL CENTER 4801 8TH STREET NORTH
ST. CLOUD MN
56303-2099
US

IV. Provider business mailing address

1 MICHAELS COURT
SARTELL MN
56377-2012
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-6465
  • Fax: 320-255-6360
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116665-5
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4721
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number116665-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: