Organization
CHILDREN'S HEALTH CARE
Active
Other names
Children's Hosptials and Clinics of MN
Organization subpart
No
Provider details
NPI number
Authorized official
CHESTEVIA GIBSON (OUTPATIENT PHARMACY MANAGER)
(612) 813-7290
Entity
Organization
Contact information
Practice address
2530 CHICAGO AVE, CSC 225, MINNEAPOLIS, MN 55404-4289
(612) 813-7290
(612) 813-7296
Mailing address
PO BOX 860123, MINNEAPOLIS, MN 55486-0112
(612) 813-7290
(612) 813-7296
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
263375
MN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137647000
—
MN
01
—
2120511
PK
—
Enumeration date
01/12/2009
Last updated
10/31/2022
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