Provider Demographics
NPI:1356352868
Name:L CHARLES SENDELBACH
Entity type:Organization
Organization Name:L CHARLES SENDELBACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SENDELBACH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:507-825-3100
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1651
Practice Address - Country:US
Practice Address - Phone:507-825-3100
Practice Address - Fax:507-825-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2610867333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110718600Medicaid
2411306OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MN0278400001Medicare NSC