Organization
MEDICATION MANAGEMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN E PEDERSON PHARM.D. (PHARM.D./OWNER)
(218) 686-5562
Entity
Organization
Contact information
Practice address
14442 RIVERBEND TRL, THIEF RIVER FALLS, MN 56701-8433
(218) 681-1750
Mailing address
14442 RIVERBEND TRL, THIEF RIVER FALLS, MN 56701-8433
(218) 686-5562
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
116988
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295851228
INDIVIDUAL NPI
MN
05
—
743688200
—
MN
Enumeration date
02/18/2009
Last updated
02/18/2009
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