Healthcare Provider Details

I. General information

NPI: 1700872280
Provider Name (Legal Business Name): HUNT SILVER LAKE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 BROADWAY AVE N
ROCHESTER MN
55906
US

IV. Provider business mailing address

1510 N BROADWAY
ROCHESTER MN
55906-4146
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-3831
  • Fax: 507-252-1731
Mailing address:
  • Phone: 507-288-3831
  • Fax: 507-252-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number264485
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number264484
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number265449
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PHILIP HOMMERDING
Title or Position: OWNER
Credential: PHARM D
Phone: 507-289-3901