Deephaven Phcy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2617598 Issued in MN

Legal business name

DEEPHAVEN PHCY INC

Doing business as

Deephaven Drug Co

Practice address

3428 County Road 101 S
Wayzata, MN 55391-3421

Phone

(952) 473-4100

NPI assigned

Apr 25, 2007

Last updated

Sep 12, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Larson

Title

Pres

Phone

(952) 473-4100

Specialties & licenses 2

Addresses

Other names 1

• DEEPHAVEN DRUG CO Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1043439359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3428 COUNTY ROAD 101 S",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553913421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3428 COUNTY ROAD 101 S",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553913421",
            "telephone_number": "952-473-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEPHAVEN PHCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "952-473-4100"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "2617598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEEPHAVEN DRUG CO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brooke Curb
• Naomi Damask
• Joshua Dean Daniel, PHARMD
• Luc Rene De la Villefromoy, DDS, MS
• Deephaven Chiropractic, P.a.
• Dental Specialist of Minnesota, PLLC (The Dental Specialist Deephaven)
• Elizabeth Deshler
• Jessica Marie Desjardins, DDS
• Luciana Alexandra Di Biagio, MSW, LGSW
• Distinctive Eyewear LLC (Northwest Eyewear)

• Community/Retail Pharmacy in Wayzata, MN
• Providers in Wayzata, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.