Provider Demographics
NPI:1063016939
Name:BORGEN, ZACHARY RYAN (PHARMD, MS, RPH)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:RYAN
Last Name:BORGEN
Suffix:
Gender:M
Credentials:PHARMD, MS, RPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 HANSACK AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9306
Mailing Address - Country:US
Mailing Address - Phone:762-234-2597
Mailing Address - Fax:
Practice Address - Street 1:15800 87TH ST NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330
Practice Address - Country:US
Practice Address - Phone:763-252-1316
Practice Address - Fax:763-252-1326
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist