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General NPI Number Information
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NPI Number | 1275654725
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Entity Type | Organization
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Legal Business Name | EAGLE DRUG OF ROCHESTER INC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 23 2ND ST SW
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City | ROCHESTER
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State | MN
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Zip | 55902-3017
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Country | US
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Telephone | 507-289-3141
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Fax | 507-289-6848
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Provider Business Mailing Address
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Address Line | 23 2ND ST SW
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City | ROCHESTER
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State | MN
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Zip | 55902-3017
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Country | US
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Telephone | 507-289-3141
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Fax | 507-289-6848
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Authorized Official
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Title or Position | OWNER
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Name | WARREN WILLIAMS
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Credential |
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Telephone | 507-289-3141
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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 | 2012371
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License Number State | MN
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