Individual
MR. MARK SIMON STANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
309 CYPRESS DR, SAINT JOSEPH, MN 56374-4683
(320) 282-6127
Mailing address
PO BOX 333, 309 CYPRESS DRIVE, SAINT JOSEPH, MN 56374-0333
(320) 282-6127
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
116267
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116267
MINNESOTA BOARD OF PHARMACY
MN
Enumeration date
02/10/2014
Last updated
02/10/2014
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