Provider Demographics
NPI:1215074877
Name:BECKER, DEANNA DOROTHY
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:DOROTHY
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 MERRIMAN CT
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-5243
Mailing Address - Country:US
Mailing Address - Phone:763-972-2670
Mailing Address - Fax:
Practice Address - Street 1:25 DIVISION ST E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1522
Practice Address - Country:US
Practice Address - Phone:763-682-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112885-5183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist