Provider Demographics
NPI:1154983989
Name:KINGSBURY, ALISON (PHARMD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3575
Mailing Address - Country:US
Mailing Address - Phone:218-829-0347
Mailing Address - Fax:
Practice Address - Street 1:108 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3575
Practice Address - Country:US
Practice Address - Phone:218-829-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1242921835P1300X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric