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General NPI Number Information
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NPI Number | 1881172872
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Entity Type | Individual
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Provider Name | LAUREL PRAIRIE RPH
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Gender | Female
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 1960 TWIN LAKES PKWY
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City | ROSEVILLE
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State | MN
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Zip | 55113-1324
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Country | US
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Telephone | 612-788-1478
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Fax | 612-788-1521
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Provider Business Mailing Address
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Address Line | 11206 QUEBEC LN N
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City | CHAMPLIN
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State | MN
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Zip | 55316-3226
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Country | US
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Telephone | 612-210-7392
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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 | 113799
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License Number State | MN
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