Provider Demographics
NPI:1376816116
Name:PEARSON, DEBORA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:MARIE
Last Name:PEARSON
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 1:10812 BUTTERNUT ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-4471
Mailing Address - Country:US
Mailing Address - Phone:763-757-9183
Mailing Address - Fax:
Practice Address - Street 1:10812 BUTTERNUT ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-4471
Practice Address - Country:US
Practice Address - Phone:763-757-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist