Provider Demographics
NPI:1851464531
Name:ARENSONS ANNANDALE PHARMACY INC
Entity Type:Organization
Organization Name:ARENSONS ANNANDALE PHARMACY INC
Other - Org Name:ARENSON HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMICIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BECHTOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-274-5415
Mailing Address - Street 1:43 OAK AVE N
Mailing Address - Street 2:P.O. BOX 309
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-1199
Mailing Address - Country:US
Mailing Address - Phone:320-274-5415
Mailing Address - Fax:866-478-8774
Practice Address - Street 1:43 OAK AVE N
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302-0309
Practice Address - Country:US
Practice Address - Phone:320-274-5415
Practice Address - Fax:866-478-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0179610001332B00000X
MN26095193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN201258800Medicaid
2403359OtherNABP
AA4174493OtherDEA
MN0179610001Medicare NSC