Provider Demographics
NPI:1346757457
Name:TWIN VALLEY PHARMACY LLC
Entity Type:Organization
Organization Name:TWIN VALLEY PHARMACY LLC
Other - Org Name:TWIN VALLEY PHARMACY- ULEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:KARLEEN
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:218-584-5147
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:TWIN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56584-0427
Mailing Address - Country:US
Mailing Address - Phone:218-584-5147
Mailing Address - Fax:218-584-8340
Practice Address - Street 1:108 VIKING AVE W.
Practice Address - Street 2:
Practice Address - City:ULEN
Practice Address - State:MN
Practice Address - Zip Code:56585
Practice Address - Country:US
Practice Address - Phone:218-584-5147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWIN VALLEY PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2654543336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy