Provider Demographics
NPI:1811350978
Name:KORECKY, RICHARD FREDRICK (PHARMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:FREDRICK
Last Name:KORECKY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 GREEN OAK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4708
Mailing Address - Country:US
Mailing Address - Phone:952-908-6091
Mailing Address - Fax:952-926-4002
Practice Address - Street 1:5900 GREEN OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4708
Practice Address - Country:US
Practice Address - Phone:952-908-6091
Practice Address - Fax:952-926-4002
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122565183500000X
WI18407-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist