Provider Information for 1376610899
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W & C APOTHECARY
Other Names:Doing Business As:THE APOTHECARYOrganization Subpart: NO
NPI: 1376610899
Last Updated: 2011-03-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1376610899 | ||||||||
| Enumeration Date | 2006-11-29 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: Mr. STEPHEN G ANDERSON R.Ph Title: Owner Phone: 3202510107 | ||||||||
| Mailing Address | 165 19TH ST S SUITE 102 SARTELL, MN 56377-2153 United States Phone: 320-251-0107 | Fax:320-251-0979 | ||||||||
| Primary Practice Address | 165 19TH ST S SUITE 102 SARTELL, MN 56377-2153 United States Phone: 320-251-0107 | Fax:320-251-0979 | ||||||||
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