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General NPI Number Information
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NPI Number | 1972892438
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Entity Type | Organization
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Legal Business Name | PHALEN FAMILY PHARMACY LTD
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 10/19/2019
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Provider Practice Location Address
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Address Line | 1001 JOHNSON PKWY STE B23
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City | SAINT PAUL
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State | MN
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Zip | 55106-3474
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Country | US
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Telephone | 651-209-9000
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Fax | 651-209-9009
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Provider Business Mailing Address
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Address Line | 1001 JOHNSON PKWY # B23
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City | SAINT PAUL
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State | MN
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Zip | 55106-3474
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Country | US
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Telephone | 651-209-9000
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Fax | 651-209-9009
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Authorized Official
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Title or Position | PHARMACIST/ OWNER
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Name | MAY XIA LO
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Credential |
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Telephone | 612-807-0269
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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 | 263673
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License Number State | MN
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