Individual
TARA MANGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1216 2ND ST SW STE M600B, ROCHESTER, MN 55902-1906
(507) 255-5731
Mailing address
1216 2ND ST SW STE M600B, ROCHESTER, MN 55902-1906
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120220
MN
Other
Enumeration date
12/20/2018
Last updated
03/30/2021
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