Healthcare Provider Details

I. General information

NPI: 1659450963
Provider Name (Legal Business Name): PARK NICOLLET HEALTH CARE PRODUCTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 PLAZA DR
EAGAN MN
55122-2612
US

IV. Provider business mailing address

3800 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number StateMN

VIII. Authorized Official

Name: CATHERINE F LENAGH
Title or Position: CFO
Credential:
Phone: 952-993-3108