Provider Demographics
NPI:1497037931
Name:FLATTEN, MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FLATTEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18267 CARSON CT NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2733
Mailing Address - Country:US
Mailing Address - Phone:763-252-1175
Mailing Address - Fax:763-252-1179
Practice Address - Street 1:18267 CARSON CT NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2733
Practice Address - Country:US
Practice Address - Phone:763-252-1175
Practice Address - Fax:763-252-1179
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16884-40183500000X
MN122051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist