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General NPI Number Information
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NPI Number | 1356275390
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Entity Type | Organization
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Legal Business Name | UNIVERSAL CONSTRUCTION SUPPLY CO LLC
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 3716 SAINT FRANCIS BLVD
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City | ANOKA
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State | MN
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Zip | 55303-1007
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Country | US
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Telephone | 612-242-3518
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 SAINT FRANCIS BLVD
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City | ANOKA
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State | MN
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Zip | 55303-1007
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Country | US
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Telephone | 612-242-3518
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD WALTHALL
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Credential |
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Telephone | 612-242-3518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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