Provider Demographics
NPI:1780152306
Name:NYA PHARMACY LLC
Entity type:Organization
Organization Name:NYA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEGERING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:651-334-7322
Mailing Address - Street 1:345 WILLIAM LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-9772
Mailing Address - Country:US
Mailing Address - Phone:651-334-7322
Mailing Address - Fax:952-442-3284
Practice Address - Street 1:402 FAXON RD N
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368-9507
Practice Address - Country:US
Practice Address - Phone:952-467-2100
Practice Address - Fax:952-467-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN561663000Medicaid