Individual
LUCAS ROBERT VANDERGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3255 VICKSBURG LN N, PLYMOUTH, MN 55447-1317
(763) 253-8917
Mailing address
8822 SHADYVIEW LN N, MAPLE GROVE, MN 55311-1490
(763) 234-9730
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
125352
MN
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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