Provider Demographics
NPI:1144550898
Name:ANDERSON, GARRETT (PHARM D)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 EGAN DR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2611
Mailing Address - Country:US
Mailing Address - Phone:952-746-2202
Mailing Address - Fax:
Practice Address - Street 1:4205 EGAN DR
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2611
Practice Address - Country:US
Practice Address - Phone:952-746-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist