1568532299 NPI number — RUSHFORD DRUG CO

Table of content: (NPI 1568532299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568532299 NPI number — RUSHFORD DRUG CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSHFORD DRUG CO
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:
WITT'S PHARMACY - HOUSTON
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:
1568532299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55943-0477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-896-4505
Provider Business Mailing Address Fax Number:
507-896-4506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 E CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55943-8619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-896-4505
Provider Business Practice Location Address Fax Number:
507-896-4506
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WITT
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-864-3238

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  114628-0 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 261934-7 , 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: 168460400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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