Dworshak, Clint M

Dworshak, Clint M is an individual health care provider with primary practice located at 5534 Lakeland Ave N , Crystal MN 55429-3121. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Dworshak, Clint M can be contacted via phone (763) 259-0188.

Contact Information

Primary practice address
5534 Lakeland Ave N Crystal MN 55429-3121
Phone: (763) 259-0188
Fax: (888) 636-9971
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 117076-4 Minnesota
Pharmacy Service Providers / Pharmacist 183500000X 4803 North Dakota

Profile Details

NPI number 1053520916
LBN Legal business name Dworshak, Clint M
Credentials PHARM.D.
Entity Individual
Sole proprietor 1 No
Enumeration date May 21st, 2007
Last updated Mar 30th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053520916 NPPES
Minnesota Other 117076-4 MN PHARMACIST LICENSE
Minnesota Other 4803 MN PHARMACIST LICENSE

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