Organization
IVERSON CORNER DRUG INC
Active
Organization
IVERSON CORNER DRUG INC
Active
Other names
IVERSON CORNER DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN OKERLUND PHARMD (PRESIDENT)
(218) 444-3000
Entity
Organization
Contact information
Practice address
408 MINNESOTA AVE NW, BEMIDJI, MN 56601-3127
(218) 444-3000
(218) 444-6640
Mailing address
408 MINNESOTA AVE NW, BEMIDJI, MN 56601-3127
(218) 444-3000
(218) 444-6640
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
260693
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046698
PK
—
05
—
506060500
—
MN
Enumeration date
09/21/2006
Last updated
10/24/2022
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