Warren Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Warren, MN
NPI 1871508481 · NPPES record last updated Jul 12, 2024
Key facts
- NPI
- 1871508481
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- WARREN PHARMACY INC
- Practice address
- 103 W Johnson Ave
Warren, MN 56762-1102 - Phone
- (218) 745-5481
- Fax
- (218) 745-5482
- NPI assigned
- Jul 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Shelby Knott, PHARMD
- Title
- President, Shareholder, Pic
- Phone
- (218) 289-5859
Corporate family (same tax ID) 1
Practitioners 1
-
Shelby Knott, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930090724 | MN | DME Supplier - Pharmacy |
0648390724 | Practice locations: Warren, MN |
| O20230413000717 | MN | Part B Supplier - Pharmacy | 0648390724 | Practice locations: Warren, MN |
National Provider Directory
- Tax ID family
- Warren Pharmacy
Locations
103 W Johnson Ave
Warren, MN 56762
Phone (218) 289-5859
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
103 W Johnson Ave
Warren, MN 56762-1102
Mailing address
103 W Johnson Ave
Warren, MN 56762-1102
Phone (218) 745-5481
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 418258800 | Medicaid | MN | |
| 2045164 | Other | PK |
Other names
- WARREN PHARMACY
Other providers in Warren, MN
- Warren Community Hospital, Inc.
- Warren Community Hospital, Inc.
- Warren Economic Development Authority
- Warren Eye Care, P.C.
- Warren Pharmacy Inc
- Warren-Alvarado-Oslo Public School District No 2176
- Anita Whalen
- Michelle Marie Woinarowicz
All providers in Warren, 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 Jul 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.