Provider Demographics
NPI:1306013099
Name:ANDERSON, DEBORAH ANN (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20250 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6869
Mailing Address - Country:US
Mailing Address - Phone:952-469-8404
Mailing Address - Fax:
Practice Address - Street 1:20250 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6869
Practice Address - Country:US
Practice Address - Phone:952-469-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist