| NPI | 1023620499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL JOHNSON Pharmacist In Charge 952-219-4071 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy |
| Additional Taxonomies | 3336M0002X Pharmacy, Mail Order Pharmacy |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2020-08-18 |