Provider Demographics
NPI:1235741620
Name:DEVINE, ALYSSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:SCHRANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:246 57TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5420
Mailing Address - Country:US
Mailing Address - Phone:763-586-9150
Mailing Address - Fax:763-586-9184
Practice Address - Street 1:246 57TH AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5420
Practice Address - Country:US
Practice Address - Phone:763-586-9150
Practice Address - Fax:763-586-9184
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist