CCS Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

263221 Issued in MN

Legal business name

CCS PHARMACY

Practice address

4203 Webber Pkwy
Minneapolis, MN 55412-1747

Phone

(612) 251-8578

NPI assigned

Jul 15, 2008

Last updated

Aug 12, 2008By 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

Justin Pacult, PHARM.D.

Title

President

Phone

(651) 894-4785

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1528222940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4203 WEBBER PKWY",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121747",
            "telephone_number": "612-251-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4203 WEBBER PKWY",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121747",
            "telephone_number": "612-251-8578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-15",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "PACULT",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-894-4785",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MN",
            "license": "263221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Compounding Pharmacy in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Compounding Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; 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.