Individual
LORI RAE PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
4205 PHEASANT RIDGE DR NE, BLAINE, MN 55449-6299
(763) 784-0334
(763) 784-0346
Mailing address
4205 PHEASANT RIDGE DR NE, BLAINE, MN 55449-6299
(763) 784-0334
(763) 784-0346
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
113669
MN
Other
Enumeration date
12/05/2020
Last updated
12/05/2020
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