MEDICARE: CROSSTOWN DRUG

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
1	333600000X	Pharmacy	259796-4	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2414693	OTHER	MN	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528148525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSTOWN DRUG

Provider Business Mailing Address
First Line	:	8400 CORAL SEA ST, SUITE 525
Second Line	:
City	:	MOUNDS VIEW
State	:	MN
Zip	:	55112-4398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 CORAL SEA ST, SUITE 525
Second Line	:
City	:	MOUNDS VIEW
State	:	MN
Zip	:	55112-4398
Country	:	US
Telephone Number	:	763-780-1500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. LARRY LINDBERG
Credential	:
Telephone Number	:	763-780-1500

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	12/17/2010

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Directions to “CROSSTOWN DRUG ” Practice Location

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