MEDICARE: BROOKPARK MARKETS LLC

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
2	3336C0003X	Community/Retail Pharmacy	262673	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2427070	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548342330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKPARK MARKETS LLC

Provider Business Mailing Address
First Line	:	14400 EXCELSIOR BLVD
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-5820
Country	:	US
Telephone Number	:	952-938-5347
Fax Number	:	952-746-5309

Provider Business Practice Location Address
First Line	:	14400 EXCELSIOR BLVD
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-5820
Country	:	US
Telephone Number	:	952-938-5347
Fax Number	:	952-746-5309

Authorized Official
Title or Position	:	PIC
Name	:	BARRY ZOSS
Credential	:
Telephone Number	:	952-938-5347

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	09/14/2009

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Directions to “BROOKPARK MARKETS LLC ” Practice Location

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