Healthcare Provider Details

I. General information

NPI: 1447883269
Provider Name (Legal Business Name): CHILDREN'S HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

PO BOX 860123
MINNEAPOLIS MN
55486-0123
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6963
  • Fax: 651-220-6966
Mailing address:
  • Phone: 651-220-6806
  • Fax: 651-220-6964

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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BUNZLI
Title or Position: MANAGER ST. PAUL PHARMACY
Credential: RPH
Phone: 651-220-6806