Provider Demographics
NPI:1043223779
Name:LUNDELL, RYAN D (RPH)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:D
Last Name:LUNDELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MICHAELS COURT
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ST. CLOUD VETERANS AFFAIRS MEDICAL CENTER
Practice Address - Street 2:4801 8TH STREET NORTH
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2099
Practice Address - Country:US
Practice Address - Phone:320-255-6465
Practice Address - Fax:320-255-6360
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116665-5183500000X
ND4721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist