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General NPI Number Information
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NPI Number | 1417918855
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Entity Type | Organization
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Legal Business Name | CHASKA SNYDER DRUG
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 802 YELLOWBRICK RD
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City | CHASKA
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State | MN
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Zip | 55318
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Country | US
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Telephone | 952-448-2737
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Fax | 952-448-5561
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Provider Business Mailing Address
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Address Line | 802 YELLOWBRICK RD
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City | CHASKA
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State | MN
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Zip | 55318
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Country | US
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Telephone | 952-448-2737
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Fax | 952-448-5561
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREG L WISER
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Credential |
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Telephone | 952-448-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2603379
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License Number State | MN
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