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General NPI Number Information
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NPI Number | 1487733408
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Entity Type | Organization
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Legal Business Name | PRAIRIESTONE PHARMACY LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 870 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3291
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Country | US
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Telephone | 651-225-2883
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Fax | 651-225-2890
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Provider Business Mailing Address
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Address Line | 2800 CAMPUS DR SUITE 30
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 763-746-7779
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Fax | 763-746-7778
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Authorized Official
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Title or Position | AR COORDINATOR
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Name | KARI HARMS
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Credential |
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Telephone | 763-746-7764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2627025
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License Number State | MN
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