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General NPI Number Information
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NPI Number | 1245657741
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Entity Type | Individual
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Provider Name | BETH REISNER
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Gender | Female
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 3708 HIGHWAY 63 N
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City | ROCHESTER
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State | MN
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Zip | 55906-3902
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Country | US
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Telephone | 507-281-0658
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Fax | 507-281-4614
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Provider Business Mailing Address
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Address Line | 3708 HIGHWAY 63 N
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City | ROCHESTER
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State | MN
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Zip | 55906-3902
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Country | US
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Telephone | 507-281-0658
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Fax | 507-281-4614
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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 | 118419
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License Number State | MN
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