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General NPI Number Information
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NPI Number | 1487253712
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Entity Type | Individual
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Provider Name | RACHEL LYNN FISK
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Gender | Female
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 10240 HUDSON RD
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City | WOODBURY
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State | MN
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Zip | 55129-9111
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Country | US
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Telephone | 651-735-5190
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Fax | 651-735-5193
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Provider Business Mailing Address
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Address Line | 4131 SALEM DR W
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City | WOODBURY
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State | MN
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Zip | 55129-9554
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Country | US
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Telephone | 651-208-3901
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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 | 117726
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License Number State | MN
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