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General NPI Number Information
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NPI Number | 1437849874
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Entity Type | Individual
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Provider Name | BHUSHAN GADAM
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Gender | Male
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 5800 BAKER RD
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City | MINNETONKA
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State | MN
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Zip | 55345-5965
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Country | US
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Telephone | 763-328-7582
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Fax |
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Provider Business Mailing Address
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Address Line | 6477 LARKSPUR LN
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City | CORCORAN
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State | MN
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Zip | 55340-4103
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Country | US
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Telephone | 763-328-7582
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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 | 120113
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License Number State | MN
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