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General NPI Number Information
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NPI Number | 1639566649
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Entity Type | Organization
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Legal Business Name | ST PAUL PHARMACY LLC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 301 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55103-2048
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Country | US
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Telephone | 651-447-7113
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Fax | 651-447-7112
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Provider Business Mailing Address
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Address Line | 301 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55103-2048
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Country | US
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Telephone | 651-447-7113
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Fax | 651-447-7112
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. KY NOUKY FANG
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Credential | PHARM D
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Telephone | 651-447-7113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 118487
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 118487
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License Number State | MN
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