Provider Demographics
NPI:1346621471
Name:MAGNUSON, STACEY MARIE (PHARMD, RPH)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARIE
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:LEDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:940 INDUSTRIAL DR S
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1271
Mailing Address - Country:US
Mailing Address - Phone:320-230-1050
Mailing Address - Fax:
Practice Address - Street 1:940 INDUSTRIAL DR S
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1271
Practice Address - Country:US
Practice Address - Phone:320-230-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist