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Organization
ST THERESE HOME INC
Active
Organization
ST THERESE HOME INC
Active
Other names
ST THERESE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AL BROSSEAU RPH (DIRECTOR OF PHARMACY)
(763) 531-5005
Entity
Organization
Contact information
Practice address
8000 BASS LAKE RD, NEW HOPE, MN 55428-3118
(763) 531-5005
(763) 531-5061
Mailing address
8000 BASS LAKE RD, #200A, NEW HOPE, MN 55428-3118
(763) 531-5005
(763) 531-5061
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
200511
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2045739
PK
—
05
—
712242001
—
MN
Enumeration date
04/03/2007
Last updated
02/20/2017
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