Healthcare Provider Details

I. General information

NPI: 1093638090
Provider Name (Legal Business Name): ANDREW BEHM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 W 78TH ST
MINNEAPOLIS MN
55439-2649
US

IV. Provider business mailing address

6009 VIRGINIA AVE S
EDINA MN
55424-1757
US

V. Phone/Fax

Practice location:
  • Phone: 612-386-1829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number116991
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: