Organization
ST THERESE HOME INC
Active
Other names
ST THERESE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AL BROSSEAU RPH (DIRECTOR OF PHARMACY)
(763) 531-5005
Entity
Organization
Contact information
Practice address
8000 BASS LAKE RD, NEW HOPE, MN 55428-3118
(763) 531-5005
(763) 531-5061
Mailing address
8000 BASS LAKE RD, #200A, NEW HOPE, MN 55428-3118
(763) 531-5005
(763) 531-5061
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
200511
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2045739
PK
—
05
—
712242001
—
MN
Enumeration date
04/03/2007
Last updated
02/20/2017
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