Healthcare Provider Details

I. General information

NPI: 1336147412
Provider Name (Legal Business Name): MCPARK LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 1ST ST S
WILLMAR MN
56201-3512
US

IV. Provider business mailing address

1110 1ST ST S
WILLMAR MN
56201-3512
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-2440
  • Fax: 320-235-7601
Mailing address:
  • Phone: 320-235-2440
  • Fax: 320-235-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2616337
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD PARKER
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 320-235-2440