Organization
BLAIRCO, INC.
Active
Other names
Trail Creek Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT E BLAIR PHARMD (PRESIDENT)
(507) 345-4302
Entity
Organization
Contact information
Practice address
120 N AUGUSTA CT STE 103, MANKATO, MN 56001-7720
(507) 345-4302
(507) 387-2917
Mailing address
120 N AUGUSTA CT STE 103, MANKATO, MN 56001-7720
(507) 345-4302
(507) 387-2917
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
263083
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263083
MN BOARD OF PHARMACY
MN
Enumeration date
09/08/2008
Last updated
03/07/2023
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