Provider Demographics
NPI:1376820084
Name:HAUGRUD, BEAU
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:
Last Name:HAUGRUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2906
Mailing Address - Country:US
Mailing Address - Phone:763-566-8350
Mailing Address - Fax:763-561-2256
Practice Address - Street 1:7700 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2906
Practice Address - Country:US
Practice Address - Phone:763-566-8350
Practice Address - Fax:763-561-2256
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist