1841215688 NPI number — B.E. DRUG, INC.

Table of content: (NPI 1841215688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841215688 NPI number — B.E. DRUG, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B.E. 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:
BLUE EARTH 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:
1841215688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 S GROVE ST
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
BLUE EARTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56013-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-526-2121
Provider Business Mailing Address Fax Number:
507-526-2298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 S GROVE ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
BLUE EARTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56013-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-526-2121
Provider Business Practice Location Address Fax Number:
507-526-2298
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZIERKE
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
507-526-2121

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  261899-5 , 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: 0526962 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136605 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 999638900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85D23BL . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2423678 . This is a "NCPDP NUMBER" identifier . This identifiers is of the category "OTHER".




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