Provider Demographics
NPI:1467902536
Name:TWIN VALLEY PHARMACY, LLC
Entity Type:Organization
Organization Name:TWIN VALLEY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:K
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:218-584-8430
Practice Address - Street 1:120 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:TWIN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56584-4000
Practice Address - Country:US
Practice Address - Phone:218-584-5147
Practice Address - Fax:218-584-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy