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General NPI Number Information
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NPI Number | 1083752075
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Entity Type | Organization
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Legal Business Name | J & L UREVIG INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 124 NE 4TH ST
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2840
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Country | US
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Telephone | 218-326-9639
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Fax | 218-326-6849
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Provider Business Mailing Address
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Address Line | 124 NE 4TH ST
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2840
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PH. TECH
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Name | LINDA UREVIG
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Credential | PH. TECH
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Telephone | 218-326-9639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2602202
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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