Provider Demographics
NPI:1831423441
Name:MUNSON, KATI (PHARMD)
Entity type:Individual
Prefix:
First Name:KATI
Middle Name:
Last Name:MUNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATI
Other - Middle Name:
Other - Last Name:WYPYSZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3696 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2229
Mailing Address - Country:US
Mailing Address - Phone:608-738-1077
Mailing Address - Fax:651-220-6964
Practice Address - Street 1:345 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2346
Practice Address - Country:US
Practice Address - Phone:651-220-6962
Practice Address - Fax:651-220-6964
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist