Provider Demographics
NPI:1679828933
Name:MOEN, MEGAN
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:MOEN
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 1:2021 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7546
Mailing Address - Country:US
Mailing Address - Phone:651-439-0992
Mailing Address - Fax:651-472-8062
Practice Address - Street 1:2021 MARKET DR
Practice Address - Street 2:T-0931
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7546
Practice Address - Country:US
Practice Address - Phone:651-439-0992
Practice Address - Fax:651-472-8062
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist