Provider Demographics
NPI:1972892438
Name:PHALEN FAMILY PHARMACY LTD
Entity Type:Organization
Organization Name:PHALEN FAMILY PHARMACY LTD
Other - Org Name:PHALEN FAMILY PHARMACY LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAY
Authorized Official - Middle Name:XIA
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-807-0269
Mailing Address - Street 1:1001 JOHNSON PKWY # B23
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3474
Mailing Address - Country:US
Mailing Address - Phone:651-209-9000
Mailing Address - Fax:651-209-9009
Practice Address - Street 1:1001 JOHNSON PKWY STE B23
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3474
Practice Address - Country:US
Practice Address - Phone:651-209-9000
Practice Address - Fax:651-209-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2636733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2430736OtherNCPDP PROVIDER IDENTIFICATION NUMBER