Provider Demographics
NPI:1356128094
Name:PHALEN FAMILY PHARMACY LTD
Entity type:Organization
Organization Name:PHALEN FAMILY PHARMACY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:651-209-9000
Mailing Address - Street 1:1001 JOHNSON PKWY STE B-23
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 B-23
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:2023-09-14
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN263673OtherSTATE LICENSE NUMBER