MEDICARE: JOHN KASTNER III

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	121318	MN

General Provider Information

NPI Number	:	1821497355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KASTNER III

Provider Business Mailing Address
First Line	:	10501 FLORIDA AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-2553
Country	:	US
Telephone Number	:	952-854-1190
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 SILVER LAKE RD NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55421-4222
Country	:	US
Telephone Number	:	612-706-1988
Fax Number	:

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

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	09/16/2016

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