Healthcare Provider Details

I. General information

NPI: 1144246430
Provider Name (Legal Business Name): USDRUGS COM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 8TH ST S STE 9
MOORHEAD MN
56560-5108
US

IV. Provider business mailing address

3505 8TH ST S STE 9
MOORHEAD MN
56560-5108
US

V. Phone/Fax

Practice location:
  • Phone: 218-284-5559
  • Fax: 218-281-5560
Mailing address:
  • Phone: 218-284-5559
  • Fax: 218-281-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262770
License Number StateMN

VIII. Authorized Official

Name: LYNN GRANI
Title or Position: PIC
Credential: RPH
Phone: 218-284-5559