Provider Demographics
NPI:1982882437
Name:CLAUSON, GARY A (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:CLAUSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:952-653-2542
Mailing Address - Fax:952-653-2540
Practice Address - Street 1:8000 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3118
Practice Address - Country:US
Practice Address - Phone:763-531-5005
Practice Address - Fax:763-531-5061
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN114452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist