Provider Demographics
NPI:1326394032
Name:BESERES, ALICIA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:BESERES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANN
Other - Last Name:ENGBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:CHILDREN'S MINNESOTA OUTPATIENT PHARMACY
Mailing Address - Street 2:2530 CHICAGO AVE S MAILSTOP 270
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-813-7292
Mailing Address - Fax:612-813-7296
Practice Address - Street 1:CHILDREN'S MINNESOTA OUTPATIENT PHARMACY
Practice Address - Street 2:345 SMITH AVE N
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6944
Practice Address - Fax:651-220-6966
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist