1356484513 NPI number — SWARD-KEMP DRUG CO INC

Table of content: (NPI 1356484513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356484513 NPI number — SWARD-KEMP DRUG CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWARD-KEMP DRUG CO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SWARD KEMP SNYDER DRUG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356484513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDWOOD FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-637-2911
Provider Business Mailing Address Fax Number:
507-637-5869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 SOUTH WASHINGTON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDWOOD FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-637-2911
Provider Business Practice Location Address Fax Number:
507-637-5869
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
507-637-2911

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  205042 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 902257100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11G23SW . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 47283SW . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".