NPI Code Detail JSON Logo

1053400655 NPI number — WHITE DRUG ENTERPRISES INC

NPI Number: 1053400655
Health Care Provider/Practitioner: WHITE DRUG ENTERPRISES INC

Information about “1053400655” NPI (WHITE DRUG ENTERPRISES INC) exists in 1053400655 in HTML format HTML  |  1053400655 in plain Text format TXT  |  1053400655 in PDF (Portable Document Format) PDF  |  1053400655 in an XML format XML  formats.

NPI Number : 1053400655 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053400655",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WHITE DRUG ENTERPRISES INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6701 EVENSTAD DR N STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAPLE GROVE",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55369-6013",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "763-513-4300",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "707 HIGHWAY 33 S STE 12",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLOQUET",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55720-2665",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "218-879-6768",
    "PracticeLocationAddressFaxNumber": "218-879-5313",
    "EnumerationDate": "10/12/2006",
    "LastUpdateDate": "10/29/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FROISTAD",
    "AuthorizedOfficialFirstName": "ANNE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "LICENSING COORDINATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "763-513-4377",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": "424-43",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "260292",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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