Provider Demographics
NPI:1891159018
Name:CI PHARMACY SERVICES, LTD
Entity Type:Organization
Organization Name:CI PHARMACY SERVICES, LTD
Other - Org Name:GUIDEPOINT PHARMACY #106
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZWALD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:218-829-3476
Mailing Address - Street 1:14091 BAXTER DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8699
Mailing Address - Country:US
Mailing Address - Phone:218-829-3473
Mailing Address - Fax:218-454-0353
Practice Address - Street 1:20 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1422
Practice Address - Country:US
Practice Address - Phone:218-546-5144
Practice Address - Fax:218-546-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2637343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2420925OtherNCPDP
MN2420925OtherNCPDP