Organization
BANADIR PHARMACY LLC
Active
Other names
Banadir Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EDRIS KOSAR (OWNER/PHARMACIST IN CHARGE)
(267) 575-1293
Entity
Organization
Contact information
Practice address
1 W LAKE ST STE 195, MINNEAPOLIS, MN 55408-3362
(612) 825-1669
(612) 825-1667
Mailing address
1 W LAKE ST STE 195, MINNEAPOLIS, MN 55408-3362
(612) 825-1669
(612) 825-1667
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
263804
MN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133164
PK
—
Enumeration date
12/20/2011
Last updated
05/01/2017
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