Provider Demographics
NPI:1235914680
Name:GERMUNDSON, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:GERMUNDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 HAMILTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3657
Mailing Address - Country:US
Mailing Address - Phone:651-239-0998
Mailing Address - Fax:
Practice Address - Street 1:750 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4829
Practice Address - Country:US
Practice Address - Phone:507-452-4076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist