MEDICARE: REDPHARM DRUG, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	2621267	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2048307	OTHER		PK

General Provider Information

NPI Number	:	1184798605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDPHARM DRUG, INC.

Provider Business Mailing Address
First Line	:	6501 CITY WEST PKWY
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3248
Country	:	US
Telephone Number	:	952-653-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 CITY WEST PKWY
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3248
Country	:	US
Telephone Number	:	952-653-2525
Fax Number	:

Authorized Official
Title or Position	:	VP OF PHCY SERVICES
Name	:	JULIE GEASON
Credential	:
Telephone Number	:	952-653-2525

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	10/27/2016

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Directions to “REDPHARM DRUG, INC. ” Practice Location

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