Provider Demographics
NPI:1750378386
Name:PRO PHARMACY II INC
Entity type:Organization
Organization Name:PRO PHARMACY II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOUWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:651-455-4140
Mailing Address - Street 1:102 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2332
Mailing Address - Country:US
Mailing Address - Phone:651-455-4140
Mailing Address - Fax:651-455-4275
Practice Address - Street 1:102 5TH AVE S
Practice Address - Street 2:
Practice Address - City:SOUTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-2332
Practice Address - Country:US
Practice Address - Phone:651-455-4140
Practice Address - Fax:651-455-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261946-0333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2402105OtherNABP #
MN6030950001Medicare NSC