=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679615629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRECKENRIDGE DRUG PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 5TH ST N
-----------------------------------------------------
City | BRECKENRIDGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56520-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-643-5411
-----------------------------------------------------
Fax | 218-643-1622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 5TH ST N
-----------------------------------------------------
City | BRECKENRIDGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56520-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-643-5411
-----------------------------------------------------
Fax | 218-643-1622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | JODI LYNN BEYER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 218-643-5411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 261997
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------