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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	263509	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2125382	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982924288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED COMMUNITY PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	800 BOONE AVE N
Second Line	:	SUITE 200
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55427-4468
Country	:	US
Telephone Number	:	763-417-8888
Fax Number	:	763-417-9999

Provider Business Practice Location Address
First Line	:	2500 NEW BRIGHTON BLVD.
Second Line	:	SUITE 105
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418
Country	:	US
Telephone Number	:	612-259-8275
Fax Number	:	612-259-8286

Authorized Official
Title or Position	:	CEO
Name	:	MARK OLSHANSKY
Credential	:
Telephone Number	:	612-990-5246

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	03/07/2020

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Directions to “UNITED COMMUNITY PHARMACY CORPORATION ” Practice Location

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