| NPI | 1679552996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE C MARTINSON Director, Revenue Management 651-696-5676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2025-08-27 |