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General NPI Number Information
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NPI Number | 1922975606
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Entity Type | Individual
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Provider Name | KATHERINE DIANNE BRASTAD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 5370 W 16TH ST
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-1734
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Country | US
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Telephone | 952-544-0542
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Fax | 952-544-0629
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Provider Business Mailing Address
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Address Line | 5370 W 16TH ST
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-1734
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Country | US
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Telephone | 952-544-0542
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Fax | 952-544-0629
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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 | 125771
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License Number State | MN
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