Organization
HANSON NORTHDALE DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BENSON (OWNER)
(763) 755-2200
Entity
Organization
Contact information
Practice address
544 NORTHDALE BLVD NW, COON RAPIDS, MN 55448-3366
(763) 755-2200
(763) 755-7328
Mailing address
544 NORTHDALE BLVD NW, COON RAPIDS, MN 55448-3366
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2601504
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2402446
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
2601504
—
MN
Enumeration date
01/30/2007
Last updated
09/12/2007
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