Healthcare Provider Details

I. General information

NPI: 1093905259
Provider Name (Legal Business Name): NORTH MEMORIAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W BROADWAY AVE STE 1150
ROBBINSDALE MN
55422-2969
US

IV. Provider business mailing address

3435 W BROADWAY AVE STE 1150
ROBBINSDALE MN
55422-2969
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-1152
  • Fax: 763-520-1976
Mailing address:
  • Phone: 763-520-1152
  • Fax: 763-520-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263023
License Number StateMN

VIII. Authorized Official

Name: STEPHANIE R GALE
Title or Position: INTERIM CFO
Credential:
Phone: 763-581-4635