Provider Demographics
NPI:1306229307
Name:JOSEPHSON, KARIN MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:MICHELLE
Last Name:JOSEPHSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:MICHELLE
Other - Last Name:RUDNINGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1406 6TH AVE N
Mailing Address - Street 2:ST CLOUD HOSPITAL
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1900
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7115
Practice Address - Street 1:1555 NORTHWAY DRIVE #200
Practice Address - Street 2:CENTRACARE FAMILY HEALTH CENTER
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4913
Practice Address - Country:US
Practice Address - Phone:320-240-3157
Practice Address - Fax:320-240-3143
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122361OtherMINNESOTA BOARD OF PHARMACY