Healthcare Provider Details

I. General information

NPI: 1639114168
Provider Name (Legal Business Name): RUSHFORD DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MAIN AVE N
HARMONY MN
55939-8888
US

IV. Provider business mailing address

PO BOX 370
RUSHFORD MN
55971-0370
US

V. Phone/Fax

Practice location:
  • Phone: 507-886-2322
  • Fax: 507-886-2905
Mailing address:
  • Phone: 507-864-3238
  • Fax: 507-864-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263284
License Number StateMN

VIII. Authorized Official

Name: THOMAS WITT
Title or Position: CEO
Credential:
Phone: 507-421-2993