Provider Demographics
NPI:1295222909
Name:A & E PHARMACY LLC
Entity Type:Organization
Organization Name:A & E PHARMACY LLC
Other - Org Name:A & E PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEURANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-238-8615
Mailing Address - Street 1:1265 GREY FOX RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6932
Mailing Address - Country:US
Mailing Address - Phone:612-238-8615
Mailing Address - Fax:877-490-1688
Practice Address - Street 1:1265 GREY FOX RD STE 300
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-6932
Practice Address - Country:US
Practice Address - Phone:612-238-8615
Practice Address - Fax:877-490-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
MN2655473336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177173OtherPK