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Individual

SAMANTHA GUSTAFSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
24760 HOSPITAL DRIVE, RED LAKE, MN 56671
(218) 679-2825
Mailing address
24769 HOSPITAL DRIVE, RED LAKE, MN 56671

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
119413
MN
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
119413
MN

Other

Enumeration date
06/26/2011
Last updated
05/11/2020
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