Healthcare Provider Details

I. General information

NPI: 1982952644
Provider Name (Legal Business Name): GARRISON DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27378 STATE HIGHWAY 18
GARRISON MN
56450-8642
US

IV. Provider business mailing address

PO BOX 425
GARRISON MN
56450-0425
US

V. Phone/Fax

Practice location:
  • Phone: 320-692-5858
  • Fax:
Mailing address:
  • Phone: 320-692-5858
  • Fax: 320-692-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262747
License Number StateMN

VIII. Authorized Official

Name: EDWARD HUPPLER
Title or Position: PHAMACIST/OWNER
Credential:
Phone: 320-532-3633