Provider Demographics
NPI:1366787590
Name:GOLDEN, DARREN LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:LEE
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25090 STUMVOLL LN
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2923
Mailing Address - Country:US
Mailing Address - Phone:218-821-1834
Mailing Address - Fax:
Practice Address - Street 1:30503 STATE HWY 371
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-2913
Practice Address - Country:US
Practice Address - Phone:218-568-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist