Provider Demographics
NPI:1568804367
Name:HCMC AMBULATORY PHARMACY
Entity Type:Organization
Organization Name:HCMC AMBULATORY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULATORY PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:612-873-6311
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:RL PHARMACY
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6311
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:RL PHARMACY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENNEPIN HEALTHCARE SYSTEMS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN264154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty