Healthcare Provider Details

I. General information

NPI: 1982793592
Provider Name (Legal Business Name): WEBER & JUDD CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 6TH ST NW
ROCHESTER MN
55901-1822
US

IV. Provider business mailing address

PO BOX 5877
ROCHESTER MN
55903-5877
US

V. Phone/Fax

Practice location:
  • Phone: 507-289-6368
  • Fax: 507-289-5348
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number260126
License Number StateMN

VIII. Authorized Official

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