Provider Demographics
NPI:1356627830
Name:ISHAUG, TARYN TERESA (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:TARYN
Middle Name:TERESA
Last Name:ISHAUG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17934 LIV LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-4102
Mailing Address - Country:US
Mailing Address - Phone:701-306-4887
Mailing Address - Fax:
Practice Address - Street 1:1155 FORD RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1099
Practice Address - Country:US
Practice Address - Phone:612-284-2197
Practice Address - Fax:612-808-6759
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist