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General NPI Number Information
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NPI Number | 1780279604
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Entity Type | Organization
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Legal Business Name | ETEL PHARMACY
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 05/23/2021
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Provider Practice Location Address
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Address Line | 2509 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55116-2837
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Country | US
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Telephone | 651-785-8280
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Fax | 612-440-2238
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Provider Business Mailing Address
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Address Line | 2509 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55116-2837
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Country | US
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Telephone | 651-785-8280
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Fax | 612-440-2238
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE/PHARMACIST
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Name | DR. BISHAW DITAMO
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Credential | PHARMD
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Telephone | 651-414-9547
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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 |
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License Number State |
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