Provider Demographics
NPI:1851850713
Name:BLOOMINGTON DRUG CO
Entity Type:Organization
Organization Name:BLOOMINGTON DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-884-7528
Mailing Address - Street 1:509 W 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4713
Mailing Address - Country:US
Mailing Address - Phone:952-884-7528
Mailing Address - Fax:
Practice Address - Street 1:509 W 98TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4713
Practice Address - Country:US
Practice Address - Phone:952-884-7528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOOMINGTON DRUG CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-19
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty