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General NPI Number Information
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NPI Number | 1972782290
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Entity Type | Organization
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Legal Business Name | GORDY'S PHARMACY INC.
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 320 SUMMIT AVE
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City | CENTER CITY
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State | MN
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Zip | 55012
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Country | US
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Telephone | 651-257-4500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 127 320 SUMMIT AVE
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City | CENTER CITY
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State | MN
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Zip | 55012-0127
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Country | US
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Telephone | 651-257-4500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM F GARRISON
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Credential | RPH
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Telephone | 651-257-4500
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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 | 2613068
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License Number State | MN
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