Provider Demographics
NPI:1982924288
Name:UNITED COMMUNITY PHARMACY CORPORATION
Entity Type:Organization
Organization Name:UNITED COMMUNITY PHARMACY CORPORATION
Other - Org Name:UNITED COMMUNITY PHARMACY CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-990-5246
Mailing Address - Street 1:800 BOONE AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4468
Mailing Address - Country:US
Mailing Address - Phone:763-417-8888
Mailing Address - Fax:763-417-9999
Practice Address - Street 1:2500 NEW BRIGHTON BLVD.
Practice Address - Street 2:SUITE 105
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418
Practice Address - Country:US
Practice Address - Phone:612-259-8275
Practice Address - Fax:612-259-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2635093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125382OtherPK
MN715415000Medicaid