Provider Demographics
NPI:1558652503
Name:HOMMERDING, PHILIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:HOMMERDING
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 1:1510 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4146
Mailing Address - Country:US
Mailing Address - Phone:507-289-3901
Mailing Address - Fax:507-529-8353
Practice Address - Street 1:1510 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4146
Practice Address - Country:US
Practice Address - Phone:507-289-3901
Practice Address - Fax:507-529-8353
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist