Provider Demographics
NPI:1700813086
Name:B & C OF CROOKSTON INC
Entity Type:Organization
Organization Name:B & C OF CROOKSTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ROPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:218-281-7045
Mailing Address - Street 1:211 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1736
Mailing Address - Country:US
Mailing Address - Phone:218-281-7045
Mailing Address - Fax:218-281-1708
Practice Address - Street 1:211 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1736
Practice Address - Country:US
Practice Address - Phone:218-281-7045
Practice Address - Fax:218-281-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN262293-63336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4775570001Medicare ID - Type Unspecified