Individual
TED PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 W LAKE ST STE 200, MINNEAPOLIS, MN 55408-3565
(612) 824-1036
Mailing address
1477 W LAKE ST # N318, MINNEAPOLIS, MN 55408-5099
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
813828
MN
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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