Provider Demographics
NPI:1477838373
Name:BADER, CARRIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 COUNTY ROAD E E
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7114
Mailing Address - Country:US
Mailing Address - Phone:651-483-2776
Mailing Address - Fax:
Practice Address - Street 1:975 COUNTY ROAD E E
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7114
Practice Address - Country:US
Practice Address - Phone:651-483-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist