| Organization Name: | INTEGRATIAVECARE VADNAIS HEIGHTS LLC |
| NPI Number: | 1508052424 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEE RYAN (PRESIDENT) |
| Mailing Address: | 5 East County Road B Suite #2 Little Canada |
| State: | MN US |
| Postal Code: | 55117 |
| Phone Number: | 6514892711 |
| Fax Number: | 6512871004 |
| NPI Enumeration Date: | 09/25/2007 |
| NPI Last Update Date: | 05/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | 262061-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |