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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