MEDICARE: ROBERT GENE MONCUR RPH

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	111011-9	MN

General Provider Information

NPI Number	:	1700895182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GENE MONCUR RPH

Provider Business Mailing Address
First Line	:	5159 W 98TH ST
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-2040
Country	:	US
Telephone Number	:	952-224-5034
Fax Number	:	952-224-5039

Provider Business Practice Location Address
First Line	:	5159 W 98TH ST
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-2040
Country	:	US
Telephone Number	:	952-224-5034
Fax Number	:	952-224-5039

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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