Healthcare Provider Details

I. General information

NPI: 1851850713
Provider Name (Legal Business Name): BLOOMINGTON DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 98TH ST
BLOOMINGTON MN
55420-4713
US

IV. Provider business mailing address

509 W 98TH ST
BLOOMINGTON MN
55420-4713
US

V. Phone/Fax

Practice location:
  • Phone: 952-884-7528
  • Fax:
Mailing address:
  • Phone: 952-884-7528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY PAUL SCHAFFER
Title or Position: OWNER/PIC
Credential:
Phone: 952-884-7528