Provider Demographics
NPI:1134745730
Name:ELKO NEW MARKET FAMILY PHARMACY, LLC
Entity type:Organization
Organization Name:ELKO NEW MARKET FAMILY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:PIVEC
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:507-412-5712
Mailing Address - Street 1:117 OLD TOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:ELKO NEW MARKET
Mailing Address - State:MN
Mailing Address - Zip Code:55054
Mailing Address - Country:US
Mailing Address - Phone:507-412-5712
Mailing Address - Fax:507-412-8291
Practice Address - Street 1:117 OLD TOWN ROAD
Practice Address - Street 2:
Practice Address - City:ELKO NEW MARKET
Practice Address - State:MN
Practice Address - Zip Code:55054
Practice Address - Country:US
Practice Address - Phone:507-412-5712
Practice Address - Fax:507-412-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN266091OtherMN BOARD OF PHARMACY