MEDICARE: PHARM ASSIST SERVICES PLLC

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	116572	MN
2	183500000X	Pharmacist	116560	MN

General Provider Information

NPI Number	:	1891017778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARM ASSIST SERVICES PLLC

Provider Business Mailing Address
First Line	:	8922 PLEASANT AVE S
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-8425
Country	:	US
Telephone Number	:	651-436-2097
Fax Number	:

Provider Business Practice Location Address
First Line	:	8922 PLEASANT AVE S
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-8425
Country	:	US
Telephone Number	:	651-436-2097
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. LAURA J KELLER
Credential	:	PHARMD
Telephone Number	:	651-436-2097

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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