NPI 1043948607

Wyatt Bader

Practitioner Pharmacist Blaine, MN

Practice location

Address: 4202 Pheasant Ridge Dr NE, Blaine, MN 55449-4529
Phone: (651) 255-1498

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 125679 (MN)

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Registry record

NPI: 1043948607
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 Aug 2022
Record last updated: 11 Aug 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.