Provider Demographics
NPI:1912518077
Name:POWERS, JOHN III
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:POWERS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1718
Mailing Address - Country:US
Mailing Address - Phone:612-824-1121
Mailing Address - Fax:612-824-2577
Practice Address - Street 1:5428 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1718
Practice Address - Country:US
Practice Address - Phone:612-824-1121
Practice Address - Fax:612-824-2577
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist