Organization
TAM OF BLACKDUCK PA
Active
Other names
MOONS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH MOON RPH (OWNER PIC)
(218) 835-7740
Entity
Organization
Contact information
Practice address
17 MAIN ST S, BLACKDUCK, MN 56630-4245
(218) 835-7740
(218) 835-7869
Mailing address
PO BOX 280, BLACKDUCK, MN 56630-0280
(218) 835-7740
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
260409
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163560300
—
MN
01
—
2044128
PK
—
Enumeration date
02/15/2007
Last updated
03/15/2017
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