Healthcare Provider Details

I. General information

NPI: 1972682771
Provider Name (Legal Business Name): RUSHFORD DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ESCH DR
CALEDONIA MN
55921-1274
US

IV. Provider business mailing address

615 ESCH DR
CALEDONIA MN
55921-1274
US

V. Phone/Fax

Practice location:
  • Phone: 507-725-3328
  • Fax: 507-725-3466
Mailing address:
  • Phone: 507-725-3328
  • Fax: 507-725-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number114628-0
License Number StateMN

VIII. Authorized Official

Name: MR. THOMAS E WITT
Title or Position: PRES., CEO
Credential: R.PH.
Phone: 507-864-3238