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Organization
GERITOM MED INC
Active
Organization
GERITOM MED INC
Active
Other names
GERITOM MED INC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON RYAN WACHTL (VICE PRESIDENT)
(952) 854-1190
Entity
Organization
Contact information
Practice address
10501 FLORIDA AVE S, BLOOMINGTON, MN 55438-2553
(952) 854-1190
(952) 854-1082
Mailing address
10501 FLORIDA AVE S, BLOOMINGTON, MN 55438-2553
(952) 854-1190
(952) 854-1082
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
261375
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046914
PK
—
05
—
718560000
—
MN
Enumeration date
10/05/2005
Last updated
09/16/2020
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