Healthcare Provider Details

I. General information

NPI: 1649883299
Provider Name (Legal Business Name): DAVID JOHN KRINGEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 01/27/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W MADISON AVE
GRANTSBURG WI
54840-7022
US

IV. Provider business mailing address

340 W WASHINGTON ST
BRAINERD MN
56401-2924
US

V. Phone/Fax

Practice location:
  • Phone: 715-463-2525
  • Fax: 715-463-5343
Mailing address:
  • Phone: 218-825-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number123784
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20946-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: