Individual
MR. RAYMOND KEITH VELLENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
7617 172ND AVE NE, FOREST LAKE, MN 55025-8873
(651) 464-5274
Mailing address
7617 172ND AVE NE, FOREST LAKE, MN 55025-8873
(651) 464-5274
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
110257
MN
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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