Individual
TIMOTHY RAY BOONSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
516 DELAWARE ST SE, SUITE 2-350, MINNEAPOLIS, MN 55455-0356
(612) 626-2828
Mailing address
516 DELAWARE ST SE, SUITE 2-350, MINNEAPOLIS, MN 55455-0356
(612) 626-2828
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
113637-1
MN
Other
Enumeration date
03/21/2012
Last updated
03/21/2012
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