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General NPI Number Information
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NPI Number | 1619809902
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Entity Type | Individual
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Provider Name | SOODABEH PESSIAN
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Gender |
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 8751 RED OAK DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-2357
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Country | US
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Telephone | 612-747-8496
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Fax |
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Provider Business Mailing Address
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Address Line | 8751 RED OAK DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-2357
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Country | US
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Telephone |
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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 | 116169
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License Number State | MN
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