Healthcare Provider Details

I. General information

NPI: 1033521273
Provider Name (Legal Business Name): WEBER & JUDD CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 9TH ST SE
ROCHESTER MN
55904-6423
US

IV. Provider business mailing address

1814 15TH ST NW
ROCHESTER MN
55901-0707
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-1422
  • Fax: 507-282-1652
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 Number264403
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

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