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General NPI Number Information
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NPI Number | 1891807897
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Entity Type | Organization
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Legal Business Name | CHANHASSEN CENTER DRUG
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 111 HUNDERTMARK RD STE 100
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City | CHASKA
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State | MN
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Zip | 55318-1194
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Country | US
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Telephone | 952-949-1002
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Fax | 952-949-0233
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Provider Business Mailing Address
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Address Line | 111 HUNDERTMARK RD SUITE 100
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City | CHASKA
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State | MN
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Zip | 55318-4551
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Country | US
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Telephone | 952-949-1002
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Fax | 952-949-0233
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Authorized Official
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Title or Position | RPH
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Name | BRUCE ANDERSON
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Credential |
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Telephone | 952-949-1002
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2625522
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License Number State | MN
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