| NPI | 1033521109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE FROISTAD Licensing COO Rdinator 763-513-4377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: WI 9265-42) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| 291U00000X Clinical Medical Laboratory | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2024-10-29 |