Provider Demographics
NPI:1386097152
Name:RISBRUDT, DARCY
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:RISBRUDT
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 1:6055 NATHAN LN N
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:763-513-4344
Mailing Address - Fax:763-248-7640
Practice Address - Street 1:6055 NATHAN LN N
Practice Address - Street 2:SUITE 200A
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1674
Practice Address - Country:US
Practice Address - Phone:763-513-4344
Practice Address - Fax:763-248-7640
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118857OtherPHARMACIST LICENSE