1245324649 NPI number — SNYDERS DRUG STORES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245324649 NPI number — SNYDERS DRUG STORES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNYDERS DRUG STORES 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:
SNYDER DRUG EMPORIUM
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:
1245324649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14525 HIGHWAY 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55345-3734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WHITE BEAR AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55106-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-771-8803
Provider Business Practice Location Address Fax Number:
651-771-3214
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RISTAU
Authorized Official First Name:
JODI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
952-936-2404

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  2618021 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 310562800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3105628 00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2402662 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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