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General NPI Number Information
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NPI Number | 1518929017
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Entity Type | Organization
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Legal Business Name | PARK NICOLLET HEALTH CARE PRODUCTS
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 6000 EARLE BROWN DR
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2506
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Country | US
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Telephone | 952-993-4801
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 PARK NICOLLET BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2527
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CATHERINE F LENAGH
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Credential |
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Telephone | 952-993-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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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 | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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