Organization
PRESCRIPTION SHOPPE IIOF DETROIT LAKES MN
Active
Other names
PRESCRIPTION SHOPPE II
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BRENK RPH (OWNER)
(218) 846-2275
Entity
Organization
Contact information
Practice address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2275
(218) 846-2114
Mailing address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2275
(218) 846-2114
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
261074
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062820400
—
MN
01
—
2417966
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/09/2006
Last updated
12/19/2009
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