Provider Demographics
NPI:1508141730
Name:GULDEN, KIRSTEN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:M
Last Name:GULDEN
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 1:7940 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1315
Mailing Address - Country:US
Mailing Address - Phone:952-252-1154
Mailing Address - Fax:952-252-1157
Practice Address - Street 1:7940 PENN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1315
Practice Address - Country:US
Practice Address - Phone:952-252-1154
Practice Address - Fax:952-252-1157
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN723152000Medicaid