Healthcare Provider Details

I. General information

NPI: 1972116671
Provider Name (Legal Business Name): RADIUS LIVING RX, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WABASHA ST S STE 100
SAINT PAUL MN
55107-1819
US

IV. Provider business mailing address

130 WABASHA ST S STE 100
SAINT PAUL MN
55107-1819
US

V. Phone/Fax

Practice location:
  • Phone: 651-829-2240
  • Fax: 651-829-2250
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LANE SIEMAN
Title or Position: PRESIDENT
Credential:
Phone: 651-829-2240