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NPI Code Detail

MEDICARE: MOUNIA RADOUANI RPH

MEDICARE: MOUNIA RADOUANI 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
1183500000XPharmacist119538MN

General Provider Information

NPI Number : 1629347323
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOUNIA RADOUANI RPH
Provider Business Mailing Address
First Line : 2500 E LAKE ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 E LAKE ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1909
Country : US
Telephone Number : 612-721-1611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2011
Last Update Date : 12/26/2011

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