Basic Information
| Provider Information | |||||||||
| NPI: | 1598946311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SELANDER | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | MARGARET | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GERMSCHEID | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | MARGARET | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHARM D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | FOND DU LAC HUMAN SERVICES DIVISION | ||||||||
| Address2: | 927 TRETTEL LANE | ||||||||
| City: | CLOQUET | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188791227 | ||||||||
| FaxNumber: | 2188782188 | ||||||||
| Practice Location | |||||||||
| Address1: | MASHKIKI WAAKAIGEN | ||||||||
| Address2: | 1433 EAST FRANKLIN AVENUE SUITE 11 & 13B | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128711989 | ||||||||
| FaxNumber: | 6128749128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2007 | ||||||||
| LastUpdateDate: | 10/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 118992 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.