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General NPI Number Information
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NPI Number | 1053647867
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Entity Type | Organization
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Legal Business Name | RUSHFORD DRUG CO
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 306 MAIN ST # 103
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City | LA CRESCENT
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State | MN
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Zip | 55947-1828
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Country | US
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Telephone | 507-895-8784
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | RUSHFORD
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State | MN
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Zip | 55971-0370
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Country | US
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Telephone | 507-864-3238
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Fax | 507-864-4207
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Authorized Official
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Title or Position | CEO
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Name | THOMAS WITT
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Credential |
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Telephone | 507-421-2993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 263440
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License Number State | MN
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