Basic Information
| Provider Information | |||||||||
| NPI: | 1477924538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTOPHERSEN | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 AMERICAN BLVD W | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554201120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528886079 | ||||||||
| FaxNumber: | 9528886095 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 AMERICAN BLVD W | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554201120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528886079 | ||||||||
| FaxNumber: | 9528886095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 122448 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.