Provider Demographics
NPI:1861437402
Name:SETZER PHARMACY INC
Entity type:Organization
Organization Name:SETZER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:651-488-0251
Mailing Address - Street 1:1685 RICE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6899
Mailing Address - Country:US
Mailing Address - Phone:651-488-0251
Mailing Address - Fax:651-488-7517
Practice Address - Street 1:1685 RICE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6899
Practice Address - Country:US
Practice Address - Phone:651-488-0251
Practice Address - Fax:651-488-7517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SETZER PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN490757400Medicaid
MN261259-3OtherSTATE PHCY LICENSE NUMBER
MN261259-3OtherSTATE PHCY LICENSE NUMBER