Provider Demographics
NPI:1871733501
Name:STORCHAK PHARMACY, LLC
Entity type:Organization
Organization Name:STORCHAK PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ZOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:612-354-3400
Mailing Address - Street 1:1200 NICOLLET MALL
Mailing Address - Street 2:
Mailing Address - City:MPLS.
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:612-354-3400
Mailing Address - Fax:612-677-3330
Practice Address - Street 1:1200 NICOLLET MALL
Practice Address - Street 2:
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:612-354-3400
Practice Address - Fax:612-677-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2633333336C0003X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN263333OtherMINNESOTTA PHARMACY LICENSE