Organization
ST. CLOUD HOSPITAL
Active
Other names
CentraCare Pharmacy at St Cloud Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW P. KUNKEL (VICE PRESIDENT)
(320) 251-2710
Entity
Organization
Contact information
Practice address
1406 SIXTH AVENUE NORTH, ST CLOUD, MN 56303
(320) 255-5670
(320) 255-5793
Mailing address
1406 SIXTH AVENUE NORTH, ST CLOUD, MN 56303
(320) 255-5670
(320) 255-5793
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2619279
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2423894
NCPDP
—
05
—
400640200
—
MN
Enumeration date
04/21/2006
Last updated
04/20/2022
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