Healthcare Provider Details

I. General information

NPI: 1740293489
Provider Name (Legal Business Name): ESSENTIA HEALTH VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 9TH STREET NORTH
VIRGINIA MN
55792
US

IV. Provider business mailing address

901 9TH ST N
VIRGINIA MN
55792-2325
US

V. Phone/Fax

Practice location:
  • Phone: 218-749-9414
  • Fax: 218-749-9565
Mailing address:
  • Phone: 218-749-9441
  • Fax: 218-749-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2608921
License Number StateMN

VIII. Authorized Official

Name: TARA MARIE PARKS
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 218-749-9414