1306229307 NPI number — KARIN MICHELLE JOSEPHSON PHARMD

Table of content: KARIN MICHELLE JOSEPHSON PHARMD (NPI 1306229307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306229307 NPI number — KARIN MICHELLE JOSEPHSON PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPHSON
Provider First Name:
KARIN
Provider Middle Name:
MICHELLE
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:
RUDNINGEN
Provider Other First Name:
KARIN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306229307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 6TH AVE N
Provider Second Line Business Mailing Address:
ST CLOUD HOSPITAL
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-251-2700
Provider Business Mailing Address Fax Number:
320-656-7115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 NORTHWAY DRIVE #200
Provider Second Line Business Practice Location Address:
CENTRACARE FAMILY HEALTH CENTER
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-4913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-240-3157
Provider Business Practice Location Address Fax Number:
320-240-3143
Provider Enumeration Date:
07/08/2015

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:  122361 , 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)

  • Identifier: 122361 . This is a "MINNESOTA BOARD OF PHARMACY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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