Organization
GERITOM MED INC
Active
Other names
GERITOM MED INC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON RYAN WACHTL (VICE PRESIDENT)
(952) 854-1190
Entity
Organization
Contact information
Practice address
10501 FLORIDA AVE S, BLOOMINGTON, MN 55438-2553
(952) 854-1190
(952) 854-1082
Mailing address
10501 FLORIDA AVE S, BLOOMINGTON, MN 55438-2553
(952) 854-1190
(952) 854-1082
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
261375
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046914
PK
—
05
—
718560000
—
MN
Enumeration date
10/05/2005
Last updated
09/16/2020
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