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NPI Code Detail

MEDICARE: ROGER JOHN PEKULA PHARMD

MEDICARE: ROGER JOHN PEKULA PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist117909MN

General Provider Information

NPI Number : 1306121470
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER JOHN PEKULA PHARMD
Provider Business Mailing Address
First Line : 2505 W DIVISION ST
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56301-3837
Country : US
Telephone Number : 320-251-9433
Fax Number : 320-251-5007
Provider Business Practice Location Address
First Line : 2505 W DIVISION ST
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56301-3837
Country : US
Telephone Number : 320-251-9433
Fax Number : 320-251-5007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 10/19/2011

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Directions to “ ROGER JOHN PEKULA PHARMD” Practice Location

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