Healthcare Provider Details

I. General information

NPI: 1972820736
Provider Name (Legal Business Name): ELLEN ANDERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 EAST SECOND STREET.
WINTHROP MN
55396
US

IV. Provider business mailing address

PO BOX T 112 2ND STREET E
WINTHROP MN
55396
US

V. Phone/Fax

Practice location:
  • Phone: 507-647-8800
  • Fax: 507-647-8805
Mailing address:
  • Phone: 507-647-8800
  • Fax: 507-647-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116992
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: