MEDICARE: JAMES EUGENE GANNON 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
1	183500000X	Pharmacist	117178	MN

General Provider Information

NPI Number	:	1750650016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EUGENE GANNON PHARM.D. RPH

Provider Business Mailing Address
First Line	:	8922 WOODHILL DR
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-3139
Country	:	US
Telephone Number	:	952-445-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 DIVISION ST S
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-2427
Country	:	US
Telephone Number	:	507-645-4455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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