Basic Information
| Provider Information | |||||||||
| NPI: | 1841439015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDWICK | ||||||||
| FirstName: | MARTI | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13926 94TH PL N | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553698931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7634206511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 AMERICAN BLVD W | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554201120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528886079 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2009 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 111932 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.