Individual provider · Type 1 NPI

Madeline Nicole Detra

Pharmacist · Anoka, MN

NPI number 1992634885 Active

Practice location

2621 Greenhaven Rd
Anoka, MN 55303-5566

Call (763) 421-5540 Map

Specialties and licenses

TaxonomyCodeLicense
Pharmacist Primary 183500000X1346244274 (MN)

Pharmacist: An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage…

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About NPI 1992634885

Madeline Nicole Detra's National Provider Identifier is 1992634885, issued on May 16, 2026. The primary taxonomy on file is Pharmacist (183500000X), and the practice location is in Anoka, MN. The record was last updated on Oct 13, 2026.