Provider Demographics
NPI:1750650016
Name:GANNON, JAMES EUGENE (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:GANNON
Suffix:
Gender:M
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8922 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-3139
Mailing Address - Country:US
Mailing Address - Phone:952-445-5440
Mailing Address - Fax:
Practice Address - Street 1:700 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2427
Practice Address - Country:US
Practice Address - Phone:507-645-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist