MEDICARE: RUSHFORD DRUG CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	114628-0	MN
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	261934-7	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568532299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSHFORD DRUG CO

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

Provider Business Practice Location Address
First Line	:	119 E CEDAR ST
Second Line	:
City	:	HOUSTON
State	:	MN
Zip	:	55943-8619
Country	:	US
Telephone Number	:	507-896-4505
Fax Number	:	507-896-4506

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS E WITT
Credential	:	RPH
Telephone Number	:	507-864-3238

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	05/11/2009

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Directions to “RUSHFORD DRUG CO ” Practice Location

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