| NPI | 1316562143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KECIA ANDERSON Pharmacist In Charge 612-386-9483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2020-11-02 |