Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
Other names
CPMG-Columbia Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LOUIS WEIR (EXECUTIVE DIRECTOR)
(763) 586-5877
Entity
Organization
Contact information
Practice address
4000 CENTRAL AVE NE, COLUMBIA HEIGHTS, MN 55421-2968
(763) 572-5710
(763) 782-8100
Mailing address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
261734-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02991CO
BCBS DME NUMBER
MN
01
—
10039288
IPC NUMBER
MN
01
—
23953
ANDA #
MN
01
—
24-23387
NABP
MN
01
—
895065
MCKESSON
MN
Enumeration date
09/22/2006
Last updated
03/07/2023
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