=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780991596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESCRIPTION DRUG ADVOCATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2010
-----------------------------------------------------
Last Update Date | 09/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11836 THORNHILL RD
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-3272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-850-2018
-----------------------------------------------------
Fax | 612-412-9440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11836 THORNHILL RD
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-3272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-850-2018
-----------------------------------------------------
Fax | 612-412-9440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MICHAEL J SIKKINK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-850-2018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------