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General NPI Number Information
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NPI Number | 1851466973
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Entity Type | Organization
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Legal Business Name | MAIN STREET PHARMACY INC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 24 3RD STREET NE
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City | OSSEO
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State | MN
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Zip | 55369
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Country | US
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Telephone | 763-493-5242
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Fax | 763-493-2621
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Provider Business Mailing Address
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Address Line | 24 3RD STREET NE
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City | OSSEO
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State | MN
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Zip | 55369
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Country | US
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Telephone | 763-493-5242
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Fax | 763-493-2621
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Authorized Official
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Title or Position | OWNER
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Name | MR. RANDALL ALVIN HOHBEIN
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Credential | RPH
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Telephone | 763-493-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2605322
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License Number State | MN
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