Individual
KYLE DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7135 E POINT DOUGLAS RD S, COTTAGE GROVE, MN 55016-3014
(651) 459-7015
Mailing address
7135 E POINT DOUGLAS RD S, COTTAGE GROVE, MN 55016-3014
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
119519
MN
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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