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Organization
CCS PHARMACY
Active
Organization
CCS PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN PACULT PHARM.D. (PRESIDENT)
(651) 894-4785
Entity
Organization
Contact information
Practice address
4203 WEBBER PKWY, MINNEAPOLIS, MN 55412-1747
(612) 251-8578
Mailing address
4203 WEBBER PKWY, MINNEAPOLIS, MN 55412-1747
(612) 251-8578
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
263221
MN
Other
Enumeration date
07/15/2008
Last updated
08/12/2008
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