Healthcare Provider Details

I. General information

NPI: 1982200739
Provider Name (Legal Business Name): BOBBI JOANN CIPALA PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 TAMARACK VLG
WOODBURY MN
55125-3383
US

IV. Provider business mailing address

8432 TAMARACK VLG
WOODBURY MN
55125-3383
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-1034
  • Fax:
Mailing address:
  • Phone: 651-702-1034
  • Fax: 651-702-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115621
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: