Healthcare Provider Details

I. General information

NPI: 1700895760
Provider Name (Legal Business Name): MINNESOTA DRUG ACQUISITION CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E 2ND ST
WINTHROP MN
55396
US

IV. Provider business mailing address

102 EAST 2ND STREET
WINTHROP MN
55396-0000
US

V. Phone/Fax

Practice location:
  • Phone: 507-647-5351
  • Fax: 507-647-6445
Mailing address:
  • Phone: 507-647-5351
  • Fax: 507-647-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263194
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH R KEAVENY
Title or Position: PRESIDENT
Credential: RPH
Phone: 612-227-7811