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General NPI Number Information
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NPI Number | 1710409792
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Entity Type | Individual
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Provider Name | ALYSSA LOUISE REAL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 2008 SUNRISE DR
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City | SAINT PETER
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State | MN
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Zip | 56082-5384
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Country | US
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Telephone | 507-931-8707
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Fax |
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Provider Business Mailing Address
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Address Line | 326 NASSAU ST
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City | SAINT PETER
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State | MN
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Zip | 56082-2020
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Country | US
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Telephone | 715-529-0052
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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 | 123403
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License Number State | MN
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