| NPI | 1962097683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA HAFNER-FOGARTY Authorized Official 612-284-8206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2021-03-04 |