Provider Demographics
NPI:1548560535
Name:NORTH MEMORIAL PHARMACY MAPLE GROVE
Entity Type:Organization
Organization Name:NORTH MEMORIAL PHARMACY MAPLE GROVE
Other - Org Name:NORTH MEMORIAL HEALTH PHARMACY - MAPLE GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-581-4768
Mailing Address - Street 1:9825 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4479
Mailing Address - Country:US
Mailing Address - Phone:763-581-9200
Mailing Address - Fax:763-581-9205
Practice Address - Street 1:9825 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4479
Practice Address - Country:US
Practice Address - Phone:763-581-9200
Practice Address - Fax:733-581-9205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MEMORIAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2635603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN263560OtherSTATE LICENSE