Organization
ST. CLOUD HOSPITAL
Active
Other names
CentraCare Pharmacy Health Plaza
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW P. KUNKEL (VICE PRESIDENT)
(320) 251-2700
Entity
Organization
Contact information
Practice address
1900 CENTRACARE CIRCLE, SUITE 1350, ST CLOUD, MN 56303
(320) 229-4904
(320) 229-5168
Mailing address
1900 CENTRACARE CIRCLE, SUITE 1350, ST CLOUD, MN 56303
(320) 229-4904
(320) 229-5168
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2620682
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05092Y800
—
MN
01
—
2424543
NCPDP
—
Enumeration date
05/08/2006
Last updated
04/20/2022
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