Healthcare Provider Details

I. General information

NPI: 1992202048
Provider Name (Legal Business Name): TWIN CITIES PHARMARCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W LAKE ST
MINNEAPOLIS MN
55408-3119
US

IV. Provider business mailing address

3945 W 141ST ST
SAVAGE MN
55378-2690
US

V. Phone/Fax

Practice location:
  • Phone: 613-315-5687
  • Fax:
Mailing address:
  • Phone: 612-250-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TEWODROS GEMEDA
Title or Position: OWNER
Credential: REGISTERED PHARMACY
Phone: 612-315-5687