Provider Demographics
NPI:1851958425
Name:RUNDQUIST, MICHELLE M (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:RUNDQUIST
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 1:8441 WAYZATA BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1372
Mailing Address - Country:US
Mailing Address - Phone:652-542-5519
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD STE 340
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1372
Practice Address - Country:US
Practice Address - Phone:652-542-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN123765OtherMN PHARMACIST LICENSE NUMBER