Provider Demographics
NPI:1356947410
Name:FLANDERS, PAUL (PHARMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FLANDERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4955
Mailing Address - Country:US
Mailing Address - Phone:952-451-0198
Mailing Address - Fax:
Practice Address - Street 1:421 3RD ST S
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4955
Practice Address - Country:US
Practice Address - Phone:952-451-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist