Organization
ERICKSON DRUG INC
Active
Other names
BLOMBERG PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT KOZIOL PHARM D (OWNER AND SEC TREAS)
(952) 469-2964
Entity
Organization
Contact information
Practice address
1583 HAMLINE AVE N, SAINT PAUL, MN 55108-2139
(651) 646-9645
(651) 632-2164
Mailing address
1583 HAMLINE AVE N, SAINT PAUL, MN 55108-2139
(651) 646-9645
(651) 632-2164
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
262902
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2416368
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
327108000
—
MN
Enumeration date
12/11/2006
Last updated
07/05/2012
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