Individual
LISA GRONNEBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1305 CORPORATE CENTER DR, EAGAN, MN 55121-1204
(612) 777-4968
Mailing address
1305 CORPORATE CENTER DR, EAGAN, MN 55121-1204
(612) 777-4968
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
118883
MN
Other
Enumeration date
10/24/2011
Last updated
12/29/2011
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