Provider Demographics
NPI:1700872280
Name:HUNT SILVER LAKE DRUG INC
Entity type:Organization
Organization Name:HUNT SILVER LAKE DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMMERDING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:507-289-3901
Mailing Address - Street 1:1510 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4146
Mailing Address - Country:US
Mailing Address - Phone:507-288-3831
Mailing Address - Fax:507-252-1731
Practice Address - Street 1:1512 BROADWAY AVE N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906
Practice Address - Country:US
Practice Address - Phone:507-288-3831
Practice Address - Fax:507-252-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2644853336L0003X
MN2644843336L0003X
MN2654493336L0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2407749OtherNCPDP #
MN610023600Medicaid
7322440002Medicare NSC