MEDICARE: POLAR PHARMACY AND MEDICAL SUPPLIES

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	183500000X	Pharmacist	113611	MN

General Provider Information

NPI Number	:	1508164575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLAR PHARMACY AND MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	2564 7TH AVE E
Second Line	:
City	:	NORTH ST PAUL
State	:	MN
Zip	:	55109-3010
Country	:	US
Telephone Number	:	651-770-6606
Fax Number	:	651-770-8017

Provider Business Practice Location Address
First Line	:	2564 7TH AVE E
Second Line	:
City	:	NORTH ST PAUL
State	:	MN
Zip	:	55109-3010
Country	:	US
Telephone Number	:	651-770-6606
Fax Number	:	651-770-8017

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LOLA ISHOLA
Credential	:	PHARMD
Telephone Number	:	651-770-6606

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	03/01/2011

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