=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750540506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN LAURIE CARLSON PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2008
-----------------------------------------------------
Last Update Date | 02/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 KIRBY DR 232 LIFE SCIENCE
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55812-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-245-1088
-----------------------------------------------------
Fax | 218-245-1283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 KIRBY DR 232 LIFE SCIENCE
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55812-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-245-1088
-----------------------------------------------------
Fax | 218-245-1283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 114219
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------