Organization
BLAIR INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
406 BELGRADE AVE, NORTH MANKATO, MN 56003-3809
(507) 387-6521
(507) 387-7982
Mailing address
406 BELGRADE AVE, NORTH MANKATO, MN 56003-3809
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2609386
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2420331
OTHER ID NUMBER
—
Enumeration date
02/21/2007
Last updated
10/04/2007
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