1790191021 NPI number — THRIFTY DRUG STORES INC.

Table of content: DR. NATASHA MUCKOVA M.D. (NPI 1790874048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790191021 NPI number — THRIFTY DRUG STORES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIFTY DRUG STORES 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:
1790191021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 EVENSTAD DR N STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-513-4300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56097-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-480-2011
Provider Business Practice Location Address Fax Number:
507-480-2017
Provider Enumeration Date:
07/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BRADER
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
763-513-4300

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 264496 , 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 NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2146915 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1790191021 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com