1114286598 NPI number — ASTRUP DRUG 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 1114286598 NPI number — ASTRUP DRUG INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASTRUP 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:
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:
1114286598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ASTRUP DRUG, INC.
Provider Second Line Business Mailing Address:
905 NORTH MAIN ST.
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-434-7428
Provider Business Mailing Address Fax Number:
507-433-1632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 MAIN AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARMONY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55939-8888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-886-2322
Provider Business Practice Location Address Fax Number:
507-886-2905
Provider Enumeration Date:
05/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
DISTRICT PHARMACY MANAGER
Authorized Official Telephone Number:
612-618-6340

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  264430 , 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: 2134944 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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