1689968067 NPI number — KJIRSTEN PEARSON PHARM D., RPH

Table of content: KJIRSTEN PEARSON PHARM D., RPH (NPI 1689968067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689968067 NPI number — KJIRSTEN PEARSON PHARM D., RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
KJIRSTEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM D., RPH
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:
1689968067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 CARLSON PARKWAY
Provider Second Line Business Mailing Address:
CP 474
Provider Business Mailing Address City Name:
MINNNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55305-5387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-992-3475
Provider Business Mailing Address Fax Number:
952-992-3475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 CARLSON PARKWAY
Provider Second Line Business Practice Location Address:
CP 474
Provider Business Practice Location Address City Name:
MINNNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55305-5387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-992-3475
Provider Business Practice Location Address Fax Number:
952-992-3475
Provider Enumeration Date:
06/03/2011

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:  118272 , 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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