Provider Demographics
NPI:1366462525
Name:PABST, JOHN (R PH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PABST
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13081 RIDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1807
Mailing Address - Country:US
Mailing Address - Phone:952-417-0322
Mailing Address - Fax:952-417-0326
Practice Address - Street 1:13081 RIDGEDALE DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1807
Practice Address - Country:US
Practice Address - Phone:952-417-0322
Practice Address - Fax:952-417-0326
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114048-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist