MEDICARE: ST CROIX DRUG COMPANY

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	332BX2000X	Oxygen Equipment & Supplies (DME)	8783612	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82-00474	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1922245398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CROIX DRUG COMPANY

Provider Business Mailing Address
First Line	:	4820 PARK GLEN RD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-5702
Country	:	US
Telephone Number	:	952-920-0460
Fax Number	:	952-920-0480

Provider Business Practice Location Address
First Line	:	4820 PARK GLEN RD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-5702
Country	:	US
Telephone Number	:	952-920-0460
Fax Number	:	952-920-0480

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	FRANCIS M SHEEHY
Credential	:
Telephone Number	:	952-920-0460

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	01/07/2009

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Directions to “ST CROIX DRUG COMPANY ” Practice Location

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