Provider Demographics
NPI:1679172522
Name:LABONNE, CARI MICHELLE
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:MICHELLE
Last Name:LABONNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 CREEKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3692
Mailing Address - Country:US
Mailing Address - Phone:218-390-7992
Mailing Address - Fax:
Practice Address - Street 1:4202 CREEKWOOD PL
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-3692
Practice Address - Country:US
Practice Address - Phone:218-390-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist