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General NPI Number Information
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NPI Number | 1962355073
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Entity Type | Organization
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Legal Business Name | EBENEZER MANAGEMENT SERVICES
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 1243 RED FOX RD
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City | ARDEN HILLS
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State | MN
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Zip | 55112-6943
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Country | US
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Telephone | 651-364-2222
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Fax | 651-364-2234
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Provider Business Mailing Address
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Address Line | 9796 VALE ST NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-5546
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Country | US
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Telephone | 612-986-7827
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | DANIEL JEROME BIEURANCE
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Credential |
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Telephone | 612-986-7827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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