Organization
WEST SIDE COMMUNITY HEALTH SERVICES INC
Active
Other names
EAST SIDE FAMILY CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA GENGLER (PIC)
(651) 793-2245
Entity
Organization
Contact information
Practice address
895 7TH ST E, SAINT PAUL, MN 55106-3871
(651) 793-2250
(651) 793-2240
Mailing address
PO BOX 9830, SALT LAKE CITY, UT 84109-9830
(651) 793-2250
(651) 793-2240
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
263192
MN
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049696
PK
—
Enumeration date
06/30/2008
Last updated
06/22/2015
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