Provider Demographics
NPI:1043924889
Name:CULBERTSON, ANTHONY TIMOTHY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TIMOTHY
Last Name:CULBERTSON
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 1:4755 PARK COMMONS DR APT 222
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4294
Mailing Address - Country:US
Mailing Address - Phone:763-567-0950
Mailing Address - Fax:
Practice Address - Street 1:9451 DUNKIRK LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311
Practice Address - Country:US
Practice Address - Phone:763-416-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist