MEDICARE: DR. RICHARD ENGLEKA 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
1	183500000X	Pharmacist	118752	MN

General Provider Information

NPI Number	:	1629698857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ENGLEKA PHARMD

Provider Business Mailing Address
First Line	:	18303 66TH PL N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-4513
Country	:	US
Telephone Number	:	651-414-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	18303 66TH PL N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-4513
Country	:	US
Telephone Number	:	651-414-3308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	04/17/2020

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