Sara Sue Andersen
Individual provider Active NPI Pharmacist · Eden Prairie, MN
NPI 1437541513 · NPPES record last updated Feb 25, 2015
Key facts
- NPI
- 1437541513
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 810308 (MN)
- Practice address
- 17979 Cobblestone Way
Eden Prairie, MN 55347-2161 - Phone
- (712) 304-0871
- NPI assigned
- Feb 25, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 810308 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 810308 | MN | Yes |
Addresses
Primary practice location
17979 Cobblestone Way
Eden Prairie, MN 55347-2161
Mailing address
17979 Cobblestone Way
Eden Prairie, MN 55347-2161
Phone (712) 304-0871
Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.