=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316343551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENNEPIN HEALTHCARE SYSTEMS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2014
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2714 COUNTY RD 88
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-873-7210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 PARK AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55415-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-873-3225
-----------------------------------------------------
Fax | 612-873-1969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LISA ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-873-9505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 263778
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------