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General NPI Number Information
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NPI Number | 1396266003
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Entity Type | Organization
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Legal Business Name | LC EDELBACH COMPANY LLC
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 160 MAIN STREET WEST
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City | WABASHA
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State | MN
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Zip | 55981
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Country | US
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Telephone | 651-560-4355
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Fax |
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Provider Business Mailing Address
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Address Line | 160 MAIN ST W
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City | WABASHA
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State | MN
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Zip | 55981-1237
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Country | US
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Telephone | 651-560-4355
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI PASSE
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Credential | PHARM D
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Telephone | 651-560-4355
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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 |
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License Number State | MN
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