Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
Other names
CPMG-Brooklyn 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
10000 ZANE AVE N, SUITE 100, BROOKLYN PARK, MN 55443-1400
(763) 569-6281
(763) 569-6211
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
262454-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02071BR
BCBS DME NUMBER
MN
01
—
076751
ANDA
MN
01
—
10118513
IPC NUMBER
MN
01
—
2426220
NABP NUMBER
MN
01
—
831146
MCKESSON
MN
Enumeration date
09/23/2006
Last updated
03/07/2023
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