Provider Demographics
NPI:1598979940
Name:LOY PFEIFFER INC
Entity Type:Organization
Organization Name:LOY PFEIFFER INC
Other - Org Name:PFEIFFER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:218-568-4011
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:30984 GOVERNMENT DR
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472
Mailing Address - Country:US
Mailing Address - Phone:218-568-4011
Mailing Address - Fax:218-568-4011
Practice Address - Street 1:30984 GOVERNMENT DRIVE
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472
Practice Address - Country:US
Practice Address - Phone:218-568-4011
Practice Address - Fax:218-568-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2006853333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN980860400OtherMN PROVIDER NUMBER