Healthcare Provider Details

I. General information

NPI: 1881750859
Provider Name (Legal Business Name): IVANHOE FAMILY PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 E GEORGE ST SUITE 1
IVANHOE MN
56142-9707
US

IV. Provider business mailing address

366 E GEORGE ST SUITE 1
IVANHOE MN
56142-9707
US

V. Phone/Fax

Practice location:
  • Phone: 507-694-1166
  • Fax: 507-694-1167
Mailing address:
  • Phone: 507-694-1166
  • Fax: 507-694-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262925
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREA ELLEN ROST
Title or Position: PHARMACIST OWNER
Credential: PHARM. D.
Phone: 507-694-1166