Healthcare Provider Details

I. General information

NPI: 1639622947
Provider Name (Legal Business Name): OUR FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNIVERSITY AVE W
SAINT PAUL MN
55103-1940
US

IV. Provider business mailing address

601 UNIVERSITY AVE W
SAINT PAUL MN
55103-1940
US

V. Phone/Fax

Practice location:
  • Phone: 651-600-3988
  • Fax: 651-788-9068
Mailing address:
  • Phone: 651-600-3988
  • Fax: 651-788-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number265127
License Number StateMN
# 2
Primary TaxonomyN
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: TRUNG NGUYEN
Title or Position: OWNER
Credential:
Phone: 651-600-3988