Provider Demographics
NPI:1295323582
Name:MJOLSNESS, FREEMAN MARAL (RPH)
Entity type:Individual
Prefix:
First Name:FREEMAN
Middle Name:MARAL
Last Name:MJOLSNESS
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 1:15710 15TH PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-2405
Mailing Address - Country:US
Mailing Address - Phone:612-419-0823
Mailing Address - Fax:
Practice Address - Street 1:17435 COUNTY ROAD 6
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-3046
Practice Address - Country:US
Practice Address - Phone:612-419-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist