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General NPI Number Information
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NPI Number | 1407095250
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Entity Type | Organization
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Legal Business Name | MEDICATION MANAGEMENT SERVICES
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 14442 RIVERBEND TRL
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-8433
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Country | US
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Telephone | 218-681-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 14442 RIVERBEND TRL
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-8433
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Country | US
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Telephone | 218-686-5562
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Fax |
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Authorized Official
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Title or Position | PHARM.D./OWNER
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Name | JAN E PEDERSON
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Credential | PHARM.D.
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Telephone | 218-686-5562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 116988
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License Number State | MN
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