Individual
DR. STACIE MARIE GALLENTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D.
Contact information
Practice address
9655 COLORADO LN N, BROOKLYN PARK, MN 55445
(763) 315-0737
Mailing address
8809 32ND CT N, NEW HOPE, MN 55427-2456
(612) 396-4257
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
118193
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118193
PHARMACIST LICENSE
MN
Enumeration date
06/27/2007
Last updated
07/08/2007
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