Healthcare Provider Details

I. General information

NPI: 1912796798
Provider Name (Legal Business Name): AFDAHL PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 CENTRAL AVE NE STE 206
COLUMBIA HEIGHTS MN
55421-2964
US

IV. Provider business mailing address

4110 CENTRAL AVE NE STE 206
COLUMBIA HEIGHTS MN
55421-2964
US

V. Phone/Fax

Practice location:
  • Phone: 763-762-8983
  • Fax: 763-207-0801
Mailing address:
  • Phone: 763-762-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FAY HASSAN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 763-218-7769