Healthcare Provider Details

I. General information

NPI: 1144281304
Provider Name (Legal Business Name): MINNESOTA ONCOLOGY HEMATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 BEAM AVE
MAPLEWOOD MN
55109-1127
US

IV. Provider business mailing address

1580 BEAM AVE
MAPLEWOOD MN
55109-1127
US

V. Phone/Fax

Practice location:
  • Phone: 651-255-8480
  • Fax: 651-779-8989
Mailing address:
  • Phone: 651-255-8480
  • Fax: 651-779-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number261921
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MEGER
Title or Position: PHARMACY MANAGER
Credential: PHARM D
Phone: 651-255-8480