1457411282 NPI number — TRUMM DRUG, INC.

Table of content: (NPI 1457411282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457411282 NPI number — TRUMM DRUG, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUMM DRUG, 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:
TRUMM DRUG GLENWOOD
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:
1457411282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 FOURTH AVE SE, SUITE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56334-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-763-3111
Provider Business Mailing Address Fax Number:
320-763-0650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 4TH AVE SE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56334-1879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-763-3111
Provider Business Practice Location Address Fax Number:
320-763-0650
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEDERSON
Authorized Official First Name:
CAITLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
320-634-4434

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  262893 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 717597 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 326653000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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