Provider Demographics
NPI:1386018273
Name:GAULKE, MIRANDA LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:LYNN
Last Name:GAULKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E TRAVELERS TRL
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2885
Mailing Address - Country:US
Mailing Address - Phone:952-894-0712
Mailing Address - Fax:
Practice Address - Street 1:300 E TRAVELERS TRL
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2885
Practice Address - Country:US
Practice Address - Phone:952-894-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist