Provider Demographics
NPI:1902987175
Name:WONDERLICH, KAREN ANN MINION (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN MINION
Last Name:WONDERLICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 ZEBULON SHORES DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6139
Mailing Address - Country:US
Mailing Address - Phone:320-632-5023
Mailing Address - Fax:
Practice Address - Street 1:207 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364
Practice Address - Country:US
Practice Address - Phone:320-468-6482
Practice Address - Fax:320-468-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1152876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist