Individual
BETHANY ROSE TALATALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2795 PILOT KNOB RD, EAGAN, MN 55121-1176
(651) 846-9245
Mailing address
4525 NATHAN LN N APT 304, PLYMOUTH, MN 55442-3151
(763) 242-2407
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
731491
MN
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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