1023151792 NPI number — DRUG EXPRESS PHARMACIES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023151792 NPI number — DRUG EXPRESS PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRUG EXPRESS PHARMACIES 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:
Provider Other Organization Name Type Code:
6
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:
1023151792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 E MINNESOTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LE CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56057-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 E MINNESOTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56057-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-357-4131
Provider Business Practice Location Address Fax Number:
507-357-4132
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OTTO
Authorized Official First Name:
DALE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
952-873-6220

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2610671 , 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: 2420951 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2420951 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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