Individual
SOUKSAVANH PHAENGKHOUANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
108 S 6TH ST, BRAINERD, MN 56401-3575
(218) 829-0347
Mailing address
108 S 6TH ST, BRAINERD, MN 56401-3575
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
121927
MN
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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