Provider Demographics
NPI:1750540506
Name:CARLSON, DAWN LAURIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:LAURIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:LAURIE
Other - Last Name:FEYEREISN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1110 KIRBY DR
Mailing Address - Street 2:232 LIFE SCIENCE
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-3003
Mailing Address - Country:US
Mailing Address - Phone:218-245-1088
Mailing Address - Fax:218-245-1283
Practice Address - Street 1:1110 KIRBY DR
Practice Address - Street 2:232 LIFE SCIENCE
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-3003
Practice Address - Country:US
Practice Address - Phone:218-245-1088
Practice Address - Fax:218-245-1283
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN367665100OtherMINNESOTA HEALTH CARE PROGRAMS (MHCP)