Healthcare Provider Details

I. General information

NPI: 1164770756
Provider Name (Legal Business Name): SP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4689 SHORELINE DRIVE SUITE 100
SPRING PARK MN
55384
US

IV. Provider business mailing address

4689 SHORELINE DR STE 100
SPRING PARK MN
55384-9715
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-2153
  • Fax: 952-471-1212
Mailing address:
  • Phone: 952-471-3784
  • Fax: 952-471-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: POUMIL PATEL
Title or Position: PRESIDENT
Credential:
Phone: 952-471-3784