Provider Demographics
NPI:1649953506
Name:ULLMAN EMMERICH, MARY ALICE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:ULLMAN EMMERICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ULLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:814 HAZEL CT
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1626
Mailing Address - Country:US
Mailing Address - Phone:651-361-0899
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1191251835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist