Provider Demographics
NPI:1639566649
Name:ST PAUL PHARMACY LLC
Entity Type:Organization
Organization Name:ST PAUL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KY
Authorized Official - Middle Name:NOUKY
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:651-447-7113
Mailing Address - Street 1:301 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2048
Mailing Address - Country:US
Mailing Address - Phone:651-447-7113
Mailing Address - Fax:651-447-7112
Practice Address - Street 1:301 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2048
Practice Address - Country:US
Practice Address - Phone:651-447-7113
Practice Address - Fax:651-447-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1184873336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy