Individual
STACEY MADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
300 CLYDESDALE TRL, MEDINA, MN 55340-4538
(763) 852-0007
Mailing address
6649 SHADYVIEW LN N, MAPLE GROVE, MN 55311-4588
(763) 229-0940
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
1-13053
KS
183500000X
Pharmacist
Primary
119094
MN
Other
Enumeration date
11/11/2011
Last updated
11/11/2011
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