| NPI | 1619396892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG BROSSEAU Secretary 952-646-3255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MS 13340) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-11-11 |