| NPI | 1912949512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS BOLTON Regional Manager 651-641-3156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MN 2624976) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-08-22 |