Provider Demographics
NPI:1063507481
Name:KASPARI, DAVID A (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KASPARI
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 1:11506 LAKE COUNTRY DR #4
Mailing Address - Street 2:
Mailing Address - City:CROSS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56442
Mailing Address - Country:US
Mailing Address - Phone:218-927-3754
Mailing Address - Fax:218-927-6349
Practice Address - Street 1:124 MINN AVE N
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431
Practice Address - Country:US
Practice Address - Phone:218-927-3754
Practice Address - Fax:218-927-6349
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1161980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist