Individual
KELLY MARIE DETHLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD.
Contact information
Practice address
901 9TH ST N, VIRGINIA, MN 55792-2325
(218) 749-9441
(218) 749-9565
Mailing address
901 9TH ST N, VIRGINIA, MN 55792-2325
(218) 749-9441
(218) 749-9565
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
118343
MN
Other
Enumeration date
01/24/2013
Last updated
01/24/2013
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