Organization
MINNESOTA DRUG ACQUISITION CO LLC
Active
Other names
Keaveny LTC Pharmacy #210
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH KEAVENY (PREIDENT)
(612) 227-7811
Entity
Organization
Contact information
Practice address
201 BROADWAY AVE S, COKATO, MN 55321-4681
(320) 286-5129
(320) 286-5434
Mailing address
PO BOX 550, COKATO, MN 55321-0550
(320) 286-5129
(320) 286-5434
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
263430
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116453317
—
MN
01
—
2429858
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/06/2009
Last updated
03/14/2013
Update your record
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