Individual
AMANDA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15250 CEDAR AVE, APPLE VALLEY, MN 55124-7017
(952) 432-5557
Mailing address
15250 CEDAR AVE, APPLE VALLEY, MN 55124-7017
(952) 432-5557
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
121968
MN
183500000X
Pharmacist
6169
SD
Other
Enumeration date
06/17/2014
Last updated
06/11/2021
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