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General NPI Number Information
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NPI Number | 1346757457
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Entity Type | Organization
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Legal Business Name | TWIN VALLEY PHARMACY LLC
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 108 VIKING AVE W.
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City | ULEN
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State | MN
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Zip | 56585
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Country | US
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Telephone | 218-584-5147
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 427
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City | TWIN VALLEY
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State | MN
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Zip | 56584-0427
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Country | US
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Telephone | 218-584-5147
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Fax | 218-584-8340
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | NICOLE KARLEEN KRUGER
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Credential | PHARMD
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Telephone | 218-584-5147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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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 | 265454
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License Number State | MN
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