Provider Demographics
NPI:1043613797
Name:REED, DAWNTE M
Entity Type:Individual
Prefix:
First Name:DAWNTE
Middle Name:M
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWNTE
Other - Middle Name:M
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:30377 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOTEN
Mailing Address - State:MN
Mailing Address - Zip Code:56316-4711
Mailing Address - Country:US
Mailing Address - Phone:320-354-3998
Mailing Address - Fax:320-354-3997
Practice Address - Street 1:30377 110TH AVE
Practice Address - Street 2:
Practice Address - City:BROOTEN
Practice Address - State:MN
Practice Address - Zip Code:56316-4711
Practice Address - Country:US
Practice Address - Phone:320-354-3998
Practice Address - Fax:320-354-3997
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist