Organization
BRAINERD MEDICAL CENTER INC
Active
Other names
Essentia Health Baxter Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TIM CERNOHOUS PHARM.D., PH.D. (DIRECTOR OF AMBULATORY PHARMACY)
(218) 786-8516
Entity
Organization
Contact information
Practice address
13060 ISLE DR, BAXTER, MN 56425-8331
(218) 454-5920
(218) 454-5921
Mailing address
13060 ISLE DR, BAXTER, MN 56425-8331
(218) 454-5920
(218) 454-5921
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
263792
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841576261
—
MN
01
—
2132596
PK
—
Enumeration date
10/31/2011
Last updated
04/18/2017
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