Provider Demographics
NPI:1114181724
Name:AVERBECK, ANNA LAURIE (PHARM/ D)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LAURIE
Last Name:AVERBECK
Suffix:
Gender:F
Credentials:PHARM/ D
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:L
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 NORTHDALE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3036
Mailing Address - Country:US
Mailing Address - Phone:763-754-9036
Mailing Address - Fax:763-754-0867
Practice Address - Street 1:2050 NORTHDALE BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3036
Practice Address - Country:US
Practice Address - Phone:763-754-9036
Practice Address - Fax:763-754-0867
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist