Deephaven Phcy Inc
Organization Active NPI Community/Retail Pharmacy · Wayzata, MN
NPI 1043439359 · NPPES record last updated Sep 12, 2007
Key facts
- NPI
- 1043439359
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2617598 (MN)
- Legal business name
- DEEPHAVEN PHCY INC
- Practice address
- 3428 County Road 101 S
Wayzata, MN 55391-3421 - Phone
- (952) 473-4100
- NPI assigned
- Apr 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Mark Larson
- Title
- Pres
- Phone
- (952) 473-4100
National Provider Directory
Locations
3428 County Road 101 S
Wayzata, MN 55391
Phone (952) 473-4100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2617598 | MN | Yes |
Addresses
Primary practice location
3428 County Road 101 S
Wayzata, MN 55391-3421
Mailing address
3428 County Road 101 S
Wayzata, MN 55391-3421
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2401634 | Other | OTHER ID NUMBER | |
| 2401634 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- DEEPHAVEN DRUG CO
Other providers in Wayzata, MN
- Brooke Curb
- Naomi Damask
- Joshua Dean Daniel
- Luc Rene De la Villefromoy
- Deephaven Chiropractic, P.a.
- Dental Specialist of Minnesota, PLLC
- Elizabeth Deshler
- Jessica Marie Desjardins
- Luciana Alexandra Di Biagio
- Distinctive Eyewear LLC
All providers in Wayzata, MN · Community/Retail Pharmacy in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.