Healthcare Provider Details

I. General information

NPI: 1972502102
Provider Name (Legal Business Name): KROON COMMUNITY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAINE AVE
ADRIAN MN
56110-0070
US

IV. Provider business mailing address

PO BOX 70
ADRIAN MN
56110-0070
US

V. Phone/Fax

Practice location:
  • Phone: 507-483-2679
  • Fax: 507-483-2173
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number260535
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MELVIN KROON
Title or Position: OWNER
Credential:
Phone: 507-483-2679