Individual
LAUREL PRAIRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1960 TWIN LAKES PKWY, ROSEVILLE, MN 55113-1324
(612) 788-1478
(612) 788-1521
Mailing address
11206 QUEBEC LN N, CHAMPLIN, MN 55316-3226
(612) 210-7392
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
113799
MN
Other
Enumeration date
08/01/2018
Last updated
08/01/2018
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