Healthcare Provider Details

I. General information

NPI: 1760675755
Provider Name (Legal Business Name): SEIP DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CENTER AVE
MOORHEAD MN
56560-1916
US

IV. Provider business mailing address

801 CENTER AVE
MOORHEAD MN
56560-1916
US

V. Phone/Fax

Practice location:
  • Phone: 218-233-1529
  • Fax: 218-233-8917
Mailing address:
  • Phone: 218-233-1529
  • Fax: 218-233-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263074
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 MANG
Credential:
Phone: 218-640-2722