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NPI Code Detail

MEDICARE: POV NHEAN

MEDICARE: POV NHEAN
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
1183500000XPharmacist124775MN

General Provider Information

NPI Number : 1376156786
Entity Type Code : Individual
Provider Name (Legal Business Name) : POV NHEAN
Provider Business Mailing Address
First Line : 2024 85TH AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55444-1495
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2024 85TH AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55444-1495
Country : US
Telephone Number : 904-252-0436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2020
Last Update Date : 08/25/2020

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Directions to “ POV NHEAN ” Practice Location

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