Provider Demographics
NPI:1194312900
Name:BACIGALUPO, NATALIE JUNE (PHARMD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JUNE
Last Name:BACIGALUPO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JUNE
Other - Last Name:HEYL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2600 RICE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-5344
Mailing Address - Country:US
Mailing Address - Phone:651-631-8202
Mailing Address - Fax:
Practice Address - Street 1:2600 RICE CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5344
Practice Address - Country:US
Practice Address - Phone:651-631-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1170431835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care