Provider Demographics
NPI:1962037242
Name:UNITED COMMUNITY PHARMACY CORPORATION
Entity Type:Organization
Organization Name:UNITED COMMUNITY PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YESILEVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-259-8275
Mailing Address - Street 1:2500 HIGHWAY 88 STE 105
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4138
Mailing Address - Country:US
Mailing Address - Phone:612-259-8275
Mailing Address - Fax:612-259-8286
Practice Address - Street 1:2500 HIGHWAY 88 STE 105
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-4138
Practice Address - Country:US
Practice Address - Phone:612-259-8275
Practice Address - Fax:612-259-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN715415000Medicaid