=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164708384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. BRET CHRISTENSON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2011
-----------------------------------------------------
Last Update Date | 11/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1585 RANDOLPH AVE
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55105-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-698-6502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29411 MORNINGSIDE CT
-----------------------------------------------------
City | LINDSTROM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55045-9523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 119680
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------