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Organization
LTC PRESCRIPTION PROVIDERS #2
Active
Organization
LTC PRESCRIPTION PROVIDERS #2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP HOMMERDING (OWNER)
(507) 289-3901
Entity
Organization
Contact information
Practice address
220 1/2 THIRD AVENUE, PROCTOR, MN 55810
(218) 628-9369
Mailing address
220 1/2 THIRD AVENUE, PROCTOR, MN 55810
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
265809
MINNESOTA PHARMACY LICENSE
MN
01
—
266589
MINNESOTAPHARMACYLICENSE
MN
Enumeration date
04/10/2019
Last updated
02/26/2026
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