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General NPI Number Information
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NPI Number | 1548560535
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Entity Type | Organization
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Legal Business Name | NORTH MEMORIAL PHARMACY MAPLE GROVE
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 9825 HOSPITAL DRIVE SUITE 100
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4479
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Country | US
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Telephone | 763-581-9200
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Fax | 733-581-9205
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Provider Business Mailing Address
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Address Line | 9825 HOSPITAL DRIVE SUITE 100
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4479
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Country | US
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Telephone | 763-581-9200
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Fax | 763-581-9205
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Authorized Official
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Title or Position | INTERIM CFO
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Name | STEPHANIE R GALE
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Credential |
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Telephone | 763-581-4635
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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 | 263560
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License Number State | MN
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