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General NPI Number Information
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NPI Number | 1780978841
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Entity Type | Organization
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Legal Business Name | MARKETPLACE PHARMACY LLC
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 5262 KYLER AVE NE STE 112
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City | ALBERTVILLE
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State | MN
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Zip | 55301-4706
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Country | US
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Telephone | 763-497-2846
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Fax | 763-497-0597
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Provider Business Mailing Address
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Address Line | 5262 KYLER AVE NE SUITE 112
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City | ALBERTVILLE
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State | MN
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Zip | 55301-4705
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Country | US
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Telephone | 763-497-2846
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Fax | 763-497-0597
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | JAMES ROE
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Credential |
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Telephone | 507-381-4794
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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 | 264143
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License Number State | MN
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