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General NPI Number Information
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NPI Number | 1366787590
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Entity Type | Individual
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Provider Name | DARREN LEE GOLDEN RPH
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Gender | Male
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 30503 STATE HWY 371
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City | PEQUOT LAKES
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State | MN
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Zip | 56472-2913
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Country | US
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Telephone | 218-568-5884
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Fax |
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Provider Business Mailing Address
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Address Line | 25090 STUMVOLL LN
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City | NISSWA
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State | MN
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Zip | 56468-2923
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Country | US
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Telephone | 218-821-1834
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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 | 115846
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License Number State | MN
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