Provider Demographics
NPI:1427160894
Name:AITKIN PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:AITKIN PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-808-0873
Mailing Address - Street 1:241 W HIGHWAY 210
Mailing Address - Street 2:
Mailing Address - City:MCGREGOR
Mailing Address - State:MN
Mailing Address - Zip Code:55760-5009
Mailing Address - Country:US
Mailing Address - Phone:218-768-4165
Mailing Address - Fax:218-768-3404
Practice Address - Street 1:241 W HIGHWAY 210
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:MN
Practice Address - Zip Code:55760-5009
Practice Address - Country:US
Practice Address - Phone:218-768-4165
Practice Address - Fax:218-768-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2636483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129026OtherPK
MN1427160894Medicaid
MN1427160894Medicaid