Provider Demographics
NPI:1871867234
Name:LUNDQUIST, ANITA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:LUNDQUIST
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 1:204 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9449
Mailing Address - Country:US
Mailing Address - Phone:715-483-0260
Mailing Address - Fax:715-483-0516
Practice Address - Street 1:1504 190TH AVE
Practice Address - Street 2:
Practice Address - City:BALSAM LAKE
Practice Address - State:WI
Practice Address - Zip Code:54810-7102
Practice Address - Country:US
Practice Address - Phone:715-825-4498
Practice Address - Fax:715-825-4499
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14948-40183500000X
MN119223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist