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General NPI Number Information
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NPI Number | 1699377697
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Entity Type | Individual
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Provider Name | DANA FORSBERG
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 100 JUNIPER AVE
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City | WADENA
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State | MN
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Zip | 56482-1041
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Country | US
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Telephone | 218-631-1723
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1225
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City | WALKER
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State | MN
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Zip | 56484-1225
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Country | US
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Telephone | 218-547-2053
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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 | 115434
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License Number State | MN
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