Provider Demographics
NPI:1689968067
Name:PEARSON, KJIRSTEN (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:KJIRSTEN
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CARLSON PARKWAY
Mailing Address - Street 2:CP 474
Mailing Address - City:MINNNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5387
Mailing Address - Country:US
Mailing Address - Phone:952-992-3475
Mailing Address - Fax:952-992-3475
Practice Address - Street 1:401 CARLSON PARKWAY
Practice Address - Street 2:CP 474
Practice Address - City:MINNNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5387
Practice Address - Country:US
Practice Address - Phone:952-992-3475
Practice Address - Fax:952-992-3475
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist