Provider Demographics
NPI:1437551116
Name:AMUNDSON, CHARMIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARMIN
Middle Name:
Last Name:AMUNDSON
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 1:1555 NORTHWAY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4555
Mailing Address - Country:US
Mailing Address - Phone:320-240-3157
Mailing Address - Fax:
Practice Address - Street 1:1555 NORTHWAY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4555
Practice Address - Country:US
Practice Address - Phone:320-240-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist