Individual
PAMELA J GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4005 VINEWOOD LN N, PLYMOUTH, MN 55442-1734
(763) 553-9731
Mailing address
4005 VINEWOOD LN N, PLYMOUTH, MN 55442-1734
(763) 553-9731
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051-033348
IL
183500000X
Pharmacist
Primary
116756-0
MN
Other
Enumeration date
09/23/2011
Last updated
09/23/2011
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