Provider Demographics
NPI:1306219464
Name:TOTAL CARE PHARMACY LLC
Entity Type:Organization
Organization Name:TOTAL CARE PHARMACY LLC
Other - Org Name:TOTAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
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:612-986-7827
Mailing Address - Street 1:7221 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3134
Mailing Address - Country:US
Mailing Address - Phone:763-444-1064
Mailing Address - Fax:763-568-7553
Practice Address - Street 1:7221 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3134
Practice Address - Country:US
Practice Address - Phone:763-444-1064
Practice Address - Fax:763-568-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2648643336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155248OtherPK