MEDICARE: PRO PHARMACY II INC

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	261946-0	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2402105	OTHER		NABP #

General Provider Information

NPI Number	:	1750378386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO PHARMACY II INC

Provider Business Mailing Address
First Line	:	102 5TH AVE S
Second Line	:
City	:	SOUTH ST PAUL
State	:	MN
Zip	:	55075-2332
Country	:	US
Telephone Number	:	651-455-4140
Fax Number	:	651-455-4275

Provider Business Practice Location Address
First Line	:	102 5TH AVE S
Second Line	:
City	:	SOUTH ST PAUL
State	:	MN
Zip	:	55075-2332
Country	:	US
Telephone Number	:	651-455-4140
Fax Number	:	651-455-4275

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MR. GREG J SCHOUWEILER
Credential	:	RPH
Telephone Number	:	651-455-4140

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	02/14/2008

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Directions to “PRO PHARMACY II INC ” Practice Location

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