Individual
TOLY TIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1960 TWIN LAKES PKWY, ROSEVILLE, MN 55113-1324
(612) 788-1478
Mailing address
5619 84 1/2 AVE N, BROOKLYN PARK, MN 55443-2171
(763) 607-9461
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
124962
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124962
MN BOARD OF PHARMACY LICENSE
MN
Enumeration date
10/11/2020
Last updated
10/11/2020
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