Healthcare Provider Details

I. General information

NPI: 1801037353
Provider Name (Legal Business Name): MCBE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 W BROADWAY
PLAINVIEW MN
55964-1257
US

IV. Provider business mailing address

PO BOX 5877
ROCHESTER MN
55903-5877
US

V. Phone/Fax

Practice location:
  • Phone: 507-534-3815
  • Fax: 507-534-2633
Mailing address:
  • Phone: 507-289-1666
  • Fax: 507-536-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263324
License Number StateMN

VIII. Authorized Official

Name: WADE HANSON
Title or Position: MANAGER
Credential:
Phone: 507-289-1666