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General NPI Number Information
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NPI Number | 1902572076
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Entity Type | Individual
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Provider Name | DEREK BRYAN ANDERSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 1130 W FRONTAGE RD
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City | OWATONNA
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State | MN
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Zip | 55060-5662
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Country | US
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Telephone | 507-451-3323
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 JEFFERSON RD APT 110
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City | NORTHFIELD
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State | MN
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Zip | 55057
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Country | US
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Telephone | 507-469-2166
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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 | 125261
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License Number State | MN
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