TAM OF BLACKDUCK PA (NPI# 1073657011) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073657011 |
| Entity Type | Organization |
| Organization Name | TAM OF BLACKDUCK PA |
| Other Organization Name | MOONS PHARMACY |
| Practice Address |
17 Main St S Blackduck MN 56630-4245 |
| Mailing Address |
Po Box 280 Blackduck MN 56630-0280 |
| Practice Telephone | 2188357740 |
| Practice Fax Number | 2188357869 |
| Mailing Telephone | 2188357740 |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2017-03-15 |
| Authorized Official Name | JOSEPH MOON (OWNER PIC) |
| Authorized Official Telephone | 2188357740 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
260409 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 163560300 | 05 | |
| PK | 2044128 | 01 |
| Other Name | Type Code |
|---|---|
| MOONS PHARMACY | Doing Business As Name - Organization |
| Street Address |
17 MAIN ST S |
| City | BLACKDUCK |
| State | MN |
| Zip Code | 56630-4245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720023252 | Moon's Pharmacy | Pharmacy | 17 Main St S, Blackduck, MN 56630 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992078802 | American Physicians of Chiropractic Science, Ltd | Chiropractor | 80 West Summit Ave, Blackduck, MN 56630 | 2012-02-23 |
| 1225203359 | Paul Roy Bengtson | Dentist | 49 Summit Ave E, Blackduck, MN 56630 | 2008-04-29 |
| 1275665028 | Thomas K O'reilly | Chiropractor | 80 Summit Ave W, Blackduck, MN 56630 | 2007-03-09 |
| 1003991944 | Blackduck Dental Clinic | Dentist | 49 Summit Ave. Se, Blackduck, MN 56630 | 2006-10-26 |
| 1548342421 | Blackduck Isd #32 | Local Education Agency (LEA) | 156 1st St Ne, Blackduck, MN 56630 | 2006-10-19 |
| 1932212693 | Blackduck Ambulance Association | Ambulance | 55 Railroad Avenue, Blackduck, MN 56630 | 2006-08-16 |
| 1306865423 | Elaine D Kelly | Physician Assistant | 1st Ave W & Margaret St, Blackduck, MN 56630 | 2006-07-19 |
| 1124045125 | Sherry S Billups | Family Medicine | 81 1st St Nw, Blackduck, MN 56630 | 2006-07-16 |
| 1831130921 | Sanford Clinic North | Family Medicine | 81 1st Street Nw, Blackduck, MN 56630 | 2006-06-09 |
| 1497736169 | The Evangelical Lutheran Good Samaritan Society | Durable Medical Equipment & Medical Supplies | 172 Summit Avenue West, Blackduck, MN 56630 | 2005-11-09 |
| Find all providers in zip 56630 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073166674 | Sanford Health of Northern Minnesota | Pharmacy | 81 1st St Nw, Ste A, Blackduck, MN 56630-0188 | 2019-07-23 |
| 1982166765 | Sanford Health of Northern Minnesota | Pharmacy | 81 1st St Nw, Ste A, Blackduck, MN 56630-0188 | 2019-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497368633 | Sawtooth Mountain Clinic, Inc. | Pharmacy | 513 5th Ave W Rm 201, Grand Marais, MN 55604-3017 | 2020-08-27 |
| 1891313326 | Rochester Community Pharmacy LLC | Pharmacy | 1604 1st St Nw, Rochester, MN 55901-0318 | 2020-07-10 |
| 1134745730 | Elko New Market Family Pharmacy, LLC | Pharmacy | 117 Old Town Road, Elko New Market, MN 55054 | 2020-06-19 |
| 1578187456 | Coborns Inc | Pharmacy | 15700 88th St Ne, Otsego, MN 55330 | 2020-06-05 |
| 1205460169 | Genoa Healthcare, LLC | Pharmacy | 1515 Energy Park Dr Ste 110, Saint Paul, MN 55108-5229 | 2020-02-28 |
| 1801438361 | The Duluth Clinic, Ltd. | Pharmacy | 2 Division St Ste A, Deer River, MN 56636-8779 | 2019-10-16 |
| 1265084792 | Nudak Ventures, LLC | Pharmacy | 5418 Saint Croix Trl, North Branch, MN 55056-4203 | 2019-07-15 |
| 1659938116 | Sterlingrx Inc | Pharmacy | 1312 Northland Dr Ste 500, Mendota Heights, MN 55120-1436 | 2019-05-21 |
| 1639734346 | Seward Pharmacy LLC | Pharmacy | 2209 E Lake St, Minneapolis, MN 55407-4563 | 2019-05-08 |
| 1093370694 | Minnesota Ave N Pharmacy Services Limited | Pharmacy | 226 Minnesota Ave N, Aitkin, MN 56431-1412 | 2019-05-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.