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General NPI Number Information
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NPI Number | 1093883605
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Entity Type | Organization
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Legal Business Name | MINNESOTA DRUG ACQUISITION CO LLC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 207 MAIN ST
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City | PIERZ
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State | MN
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Zip | 56364
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Country | US
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Telephone | 320-468-6482
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Fax | 320-468-0041
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Provider Business Mailing Address
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Address Line | 7645 E 63RD ST STE 105
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City | TULSA
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State | OK
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Zip | 74133-1208
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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 | PRESIDENT
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Name | DEBORAH KEAVENY
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Credential |
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Telephone | 612-227-7811
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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 | 263320
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License Number State | MN
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