Healthcare Provider Details

I. General information

NPI: 1215825633
Provider Name (Legal Business Name): ALAN J MONROE CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BUNKER HILL DR
AITKIN MN
56431-1865
US

IV. Provider business mailing address

23794 CEDAR LAKE DR
AITKIN MN
56431-5010
US

V. Phone/Fax

Practice location:
  • Phone: 218-927-2121
  • Fax:
Mailing address:
  • Phone: 218-851-3248
  • Fax: 218-851-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number738430
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number738430
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: