| NPI | 1225122625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI RISTAU Director 952-936-2404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: MN 2618076) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-11-24 |