1134854920 NPI number — ANNA CLAIRE MCCUSKER NEIN PHARMD

Table of content: ANNA CLAIRE MCCUSKER NEIN PHARMD (NPI 1134854920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134854920 NPI number — ANNA CLAIRE MCCUSKER NEIN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEIN
Provider First Name:
ANNA
Provider Middle Name:
CLAIRE MCCUSKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134854920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 HIGHWAY 10 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT LAKES
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56501-3046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-847-9248
Provider Business Mailing Address Fax Number:
218-847-8874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 MARKET DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERHAM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56573-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-346-4840
Provider Business Practice Location Address Fax Number:
877-795-9596
Provider Enumeration Date:
07/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  125682 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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