Provider Demographics
NPI:1972109080
Name:HUMPHREY, ALLIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:HUMPHREY
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 1:4801 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-2636
Mailing Address - Country:US
Mailing Address - Phone:952-935-1053
Mailing Address - Fax:
Practice Address - Street 1:4801 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-2636
Practice Address - Country:US
Practice Address - Phone:952-935-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist