Provider Demographics
NPI:1154698371
Name:SODAHL, KRISTA MARIE (PHARM D)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:SODAHL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7845 PORTLAND AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1312
Mailing Address - Country:US
Mailing Address - Phone:952-881-1253
Mailing Address - Fax:952-881-2656
Practice Address - Street 1:7845 PORTLAND AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1312
Practice Address - Country:US
Practice Address - Phone:952-881-1253
Practice Address - Fax:952-881-2656
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist