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General NPI Number Information
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NPI Number | 1073499265
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Entity Type | Individual
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Provider Name | CARSON SMITH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 6300 WEDGWOOD RD N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-3647
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Country | US
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Telephone | 763-551-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 18395 95TH PL N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-1293
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Country | US
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Telephone | 612-616-5494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 127011
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License Number State | MN
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