Provider Demographics
NPI:1730714916
Name:SEDRAK, NERMINE
Entity type:Individual
Prefix:
First Name:NERMINE
Middle Name:
Last Name:SEDRAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21386 HYALITE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7936
Mailing Address - Country:US
Mailing Address - Phone:952-797-2168
Mailing Address - Fax:952-423-3252
Practice Address - Street 1:15115 DOVE TRL
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7871
Practice Address - Country:US
Practice Address - Phone:952-423-3200
Practice Address - Fax:952-423-3252
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist