Individual
DIANE KOETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
12480 ABERDEEN ST NE, BLAINE, MN 55449-4721
(763) 862-6596
Mailing address
954 154TH AVE NE, HAM LAKE, MN 55304-5563
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
121785
MN
183500000X
Pharmacist
RPH5666
ND
Other
Enumeration date
09/25/2014
Last updated
07/14/2022
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