Healthcare Provider Details

I. General information

NPI: 1073095998
Provider Name (Legal Business Name): MY MEDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 BROADWAY ST NE STE 206
MINNEAPOLIS MN
55413-3700
US

IV. Provider business mailing address

807 BROADWAY ST NE STE 206
MINNEAPOLIS MN
55413-3700
US

V. Phone/Fax

Practice location:
  • Phone: 612-812-6882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJIV R SHAH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 612-333-9260