Organization
ELK RIVER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH LEEDAHL PHARMD (PRESIDENT)
(763) 441-1353
Entity
Organization
Contact information
Practice address
323 JACKSON AVE NW, ELK RIVER, MN 55330
(763) 441-1353
Mailing address
323 JACKSON AVE NW, ELK RIVER, MN 55330
(763) 441-1353
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
261701
MN
3336C0003X
Community/Retail Pharmacy
Primary
265251
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2043890
PK
—
Enumeration date
07/13/2005
Last updated
12/20/2017
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