MEDICARE: RICHARD JOSEF KRIKAVA R.PH.

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	115445-0	MN

General Provider Information

NPI Number	:	1952455669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JOSEF KRIKAVA R.PH.

Provider Business Mailing Address
First Line	:	404 HEATHER AVE
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-3019
Country	:	US
Telephone Number	:	218-878-1559
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E 1ST ST.
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55805-1901
Country	:	US
Telephone Number	:	218-786-1685
Fax Number	:	218-786-1699

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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