# ST THERESE HOME INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST THERESE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003937582
- **Authorized official:** AL BROSSEAU RPH (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (763) 531-5005

## Contact information

- **Practice address:** 8000 BASS LAKE RD, NEW HOPE, MN 55428-3118
- **Practice address phone:** (763) 531-5005
- **Practice address fax:** (763) 531-5061
- **Mailing address:** 8000 BASS LAKE RD, \#200A, NEW HOPE, MN 55428-3118
- **Mailing address phone:** (763) 531-5005
- **Mailing address fax:** (763) 531-5061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 200511 | MN | Yes |

## Other

- **Enumeration date:** 04/03/2007
- **Last updated:** 02/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2045739 | PK | — |
| 05 | — | 712242001 | — | MN |