# GERITOM MED INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GERITOM MED INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285621193
- **Authorized official:** DR. JASON RYAN WACHTL (VICE PRESIDENT)
- **Authorized official phone:** (952) 854-1190

## Contact information

- **Practice address:** 10501 FLORIDA AVE S, BLOOMINGTON, MN 55438-2553
- **Practice address phone:** (952) 854-1190
- **Practice address fax:** (952) 854-1082
- **Mailing address:** 10501 FLORIDA AVE S, BLOOMINGTON, MN 55438-2553
- **Mailing address phone:** (952) 854-1190
- **Mailing address fax:** (952) 854-1082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 261375 | MN | Yes |

## Other

- **Enumeration date:** 10/05/2005
- **Last updated:** 09/16/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2046914 | PK | — |
| 05 | — | 718560000 | — | MN |