Provider Demographics
NPI:1225371701
Name:MEDICATION THERAPY MANAGEMENT INC. P.C.
Entity Type:Organization
Organization Name:MEDICATION THERAPY MANAGEMENT INC. P.C.
Other - Org Name:MEDICATION THERAPY MANAGEMENT SERVICE AT MANKATO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TSUHUA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:507-301-6867
Mailing Address - Street 1:1320 ITHILIEN
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-9032
Mailing Address - Country:US
Mailing Address - Phone:507-301-6867
Mailing Address - Fax:952-474-3220
Practice Address - Street 1:1320 ITHILIEN
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-9032
Practice Address - Country:US
Practice Address - Phone:507-301-6867
Practice Address - Fax:952-474-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1835P0018X, 261QM2500X, 261QP2300X, 261QR1100X, 3336L0003X
MN2640773336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Multi-Specialty
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141905OtherPK
MN2432083OtherNCPDP