# LTC PRESCRIPTION PROVIDERS \#2

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720541337
- **Authorized official:** PHILIP HOMMERDING (OWNER)
- **Authorized official phone:** (507) 289-3901

## Contact information

- **Practice address:** 220 1/2 THIRD AVENUE, PROCTOR, MN 55810
- **Practice address phone:** (218) 628-9369
- **Mailing address:** 220 1/2 THIRD AVENUE, PROCTOR, MN 55810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/10/2019
- **Last updated:** 02/26/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 265809 | MINNESOTA PHARMACY LICENSE | MN |
| 01 | — | 266589 | MINNESOTAPHARMACYLICENSE | MN |