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Organization
MINNESOTA STATE COLLEGES
Active
Organization
MINNESOTA STATE COLLEGES
Active
Other names
ST. CLOUD STATE UNIVERSITY HEALTH SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN LEAF BS (PHARMACIST IN CHARGE)
(320) 308-4852
Entity
Organization
Contact information
Practice address
251 6TH ST S, SAINT CLOUD, MN 56301-4491
(320) 308-4852
(320) 308-4878
Mailing address
720 4TH AVE S, SAINT CLOUD, MN 56301-4442
(320) 308-4852
(320) 308-4878
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
200814
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2045128
PK
—
05
—
492760500
—
MN
Enumeration date
03/11/2006
Last updated
10/11/2016
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