Individual
MADILYN BOMMERSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
3620 TEXAS AVE S, ST LOUIS PARK, MN 55426-4057
(952) 933-3177
Mailing address
100 8TH AVE S UNIT 312, HOPKINS, MN 55343-4609
(701) 535-0484
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
125700
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125700
BOARD OF PHARMACY
MN
Enumeration date
08/03/2022
Last updated
08/03/2022
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