Individual
LAURA G CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM.D
Contact information
Practice address
14700 LAC LAVON DR, BURNSVILLE, MN 55306
(952) 432-4471
Mailing address
14700 LAC LAVON DR, BURNSVILLE, MN 55306-6398
(651) 249-8716
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
122240
MN
183500000X
Pharmacist
15770-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295002095
—
MN
Enumeration date
11/21/2011
Last updated
12/26/2022
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