Provider Demographics
NPI:1780661082
Name:CHRISTIANSEN, PHILIP R (RPH)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10628 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960-2042
Mailing Address - Country:US
Mailing Address - Phone:507-289-9178
Mailing Address - Fax:
Practice Address - Street 1:MAYO CLINIC PHARMACY
Practice Address - Street 2:200 FIRST STREET SW
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113019-9183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist