Organization
KOZAK INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GUST RPH (OWNER PHARMACIST)
(218) 879-1501
Entity
Organization
Contact information
Practice address
419 SKYLINE BLVD, CLOQUET, MN 55720-1164
(218) 879-1501
(218) 879-4661
Mailing address
419 SKYLINE BLVD, CLOQUET, MN 55720-1164
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
2615642
MN
3336C0003X
Community/Retail Pharmacy
Primary
2615642
MN
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2404173
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
03/07/2023
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