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General NPI Number Information
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NPI Number | 1225105885
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Entity Type | Organization
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Legal Business Name | AM CORNER DRUG INC.
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 817 MARYLAND AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-2535
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Country | US
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Telephone | 651-771-0703
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Fax | 651-771-2706
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Provider Business Mailing Address
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Address Line | 817 MARYLAND AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-2535
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Country | US
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Telephone | 651-771-0703
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Fax | 651-771-2706
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MA HER
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Credential |
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Telephone | 651-771-0703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2624442
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License Number State | MN
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