Provider Demographics
NPI:1972556983
Name:KRUEGER, VERNON D (RPH)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:D
Last Name:KRUEGER
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 1:3635 SARATOGA LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2435
Mailing Address - Country:US
Mailing Address - Phone:763-546-0630
Mailing Address - Fax:
Practice Address - Street 1:12880 ELM CREEK BLVD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7052
Practice Address - Country:US
Practice Address - Phone:763-420-3005
Practice Address - Fax:763-420-8624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist