Provider Demographics
NPI:1881970861
Name:LINDGREN, MARK J (PHARMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:LINDGREN
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 1:1665 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1611
Mailing Address - Country:US
Mailing Address - Phone:651-251-1933
Mailing Address - Fax:651-251-1936
Practice Address - Street 1:1665 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1611
Practice Address - Country:US
Practice Address - Phone:651-251-1933
Practice Address - Fax:651-251-1936
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist