MEDICARE: UNITED COMMUNITY PHARMACY CORPORATION

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	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962037242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED COMMUNITY PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	2500 HIGHWAY 88 STE 105
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-4138
Country	:	US
Telephone Number	:	612-259-8275
Fax Number	:	612-259-8286

Provider Business Practice Location Address
First Line	:	2500 HIGHWAY 88 STE 105
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-4138
Country	:	US
Telephone Number	:	612-259-8275
Fax Number	:	612-259-8286

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. DAVID YESILEVSKIY
Credential	:
Telephone Number	:	612-259-8275

Provider Enumeration Date	:	03/07/2020
Last Update Date	:	03/07/2020

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Directions to “UNITED COMMUNITY PHARMACY CORPORATION ” Practice Location

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