Provider Demographics
NPI:1699028761
Name:GILBERTSON, CAROLYN LESLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LESLIE
Last Name:GILBERTSON
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 1:4079 DOUGLAS DR N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1617
Mailing Address - Country:US
Mailing Address - Phone:612-730-7078
Mailing Address - Fax:
Practice Address - Street 1:11990 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2005
Practice Address - Country:US
Practice Address - Phone:763-354-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist