Provider Demographics
NPI:1003183203
Name:HOLMQUIST, NATHAN A (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:A
Last Name:HOLMQUIST
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 SHENANDOAH LANE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446
Mailing Address - Country:US
Mailing Address - Phone:763-252-1300
Mailing Address - Fax:
Practice Address - Street 1:6025 SHENANDOAH LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4557
Practice Address - Country:US
Practice Address - Phone:763-252-1300
Practice Address - Fax:763-252-1306
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist