Healthcare Provider Details

I. General information

NPI: 1235486424
Provider Name (Legal Business Name): GARRISON DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27378 ST HWY 27
GARRISON MN
56450
US

IV. Provider business mailing address

PO BOX 249 516 MAIN STREET
ONAMIA MN
56359-0249
US

V. Phone/Fax

Practice location:
  • Phone: 320-692-5858
  • Fax: 320-692-5859
Mailing address:
  • Phone: 320-532-3633
  • Fax: 320-532-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262747
License Number StateMN

VIII. Authorized Official

Name: MR. EDWARD GEORGE HUPPLER
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 320-532-3633