1831274778 NPI number — BYERLYS INC

Table of content: (NPI 1831274778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831274778 NPI number — BYERLYS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYERLYS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUNDS & BYERLYS PHARMACY #1011
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831274778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3948 W 50TH ST
Provider Second Line Business Mailing Address:
SUITE B-102
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55424-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-540-4748
Provider Business Mailing Address Fax Number:
801-716-4872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 COUNTY ROAD 42 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55306-5706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-435-8145
Provider Business Practice Location Address Fax Number:
952-435-5513
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
JODI
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. MANAGER, PHARMACY OPS
Authorized Official Telephone Number:
952-915-3736

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 262986 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 394407000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2048570 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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