Provider Demographics
NPI:1457112815
Name:MINNEHAHA PHARMACY INC
Entity Type:Organization
Organization Name:MINNEHAHA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMI
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:651-307-9898
Mailing Address - Street 1:757 MILTON ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1530
Mailing Address - Country:US
Mailing Address - Phone:651-307-9898
Mailing Address - Fax:651-318-0955
Practice Address - Street 1:757 MILTON ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1530
Practice Address - Country:US
Practice Address - Phone:651-307-9898
Practice Address - Fax:651-318-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy