Provider Demographics
NPI:1326024795
Name:EBNER, NANCY A (RPH)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:EBNER
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 1:500 STINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2615
Mailing Address - Country:US
Mailing Address - Phone:612-676-3254
Mailing Address - Fax:
Practice Address - Street 1:500 STINSON BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2615
Practice Address - Country:US
Practice Address - Phone:612-676-3254
Practice Address - Fax:612-884-2435
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113557-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist