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NPI Code Detail

MEDICARE: MS. STACEY MARIE MAGNUSON PHARM.D., RPH

MEDICARE: MS. STACEY MARIE MAGNUSON PHARM.D., RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist122228MN

General Provider Information

NPI Number : 1346621471
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STACEY MARIE MAGNUSON PHARM.D., RPH
Provider Business Mailing Address
First Line : 940 INDUSTRIAL DR S
Second Line :
City : SAUK RAPIDS
State : MN
Zip : 56379-1271
Country : US
Telephone Number : 320-230-1050
Fax Number :
Provider Business Practice Location Address
First Line : 940 INDUSTRIAL DR S
Second Line :
City : SAUK RAPIDS
State : MN
Zip : 56379-1271
Country : US
Telephone Number : 320-230-1050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2015
Last Update Date : 04/27/2017

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