Provider Demographics
NPI:1104965151
Name:ARNESON PHARMACY INC
Entity type:Organization
Organization Name:ARNESON PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-269-6412
Mailing Address - Street 1:1234 E HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 E HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1705
Practice Address - Country:US
Practice Address - Phone:320-269-6412
Practice Address - Fax:320-269-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MN26228393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2406850OtherOTHER ID NUMBER
2406850OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2406850OtherOTHER ID NUMBER-COMMERCIAL NUMBER