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General NPI Number Information
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NPI Number | 1033135611
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Entity Type | Organization
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Legal Business Name | SERVICE DRUG OF BRAINERD, INC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 218 W WASHINGTON ST
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City | BRAINERD
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State | MN
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Zip | 56401-2922
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Country | US
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Telephone | 218-829-3664
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Fax | 218-829-8979
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Provider Business Mailing Address
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Address Line | 218 W WASHINGTON ST
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City | BRAINERD
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State | MN
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Zip | 56401-2922
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Country | US
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Telephone | 218-829-3664
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Fax | 218-829-8979
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MS. TRECIA WIEWEL II
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Credential | RPH
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Telephone | 218-829-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2604048
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License Number State | MN
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