Healthcare Provider Details

I. General information

NPI: 1932251402
Provider Name (Legal Business Name): PHARMACEUTICAL CARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 NEWPORT DR SUITE 200
EDINA MN
55436-1726
US

IV. Provider business mailing address

PO BOX 5003
HOPKINS MN
55343-1003
US

V. Phone/Fax

Practice location:
  • Phone: 612-384-3784
  • Fax:
Mailing address:
  • Phone: 612-384-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number262492-1
License Number StateMN

VIII. Authorized Official

Name: MR. BARRY M KRELITZ
Title or Position: CEO
Credential: RPH.
Phone: 612-384-3784