Healthcare Provider Details

I. General information

NPI: 1609108141
Provider Name (Legal Business Name): SEIP DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ASPEN AVENUE NE
MENAHGA MN
56464-0272
US

IV. Provider business mailing address

PO BOX 272
MENAHGA MN
56464-0272
US

V. Phone/Fax

Practice location:
  • Phone: 218-564-4655
  • Fax: 218-564-4797
Mailing address:
  • Phone: 218-564-4655
  • Fax: 218-564-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263486
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATHAN SEIP
Title or Position: CHIEF MANAGER
Credential:
Phone: 218-385-3360