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General NPI Number Information
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NPI Number | 1083056584
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Entity Type | Organization
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Legal Business Name | THRIFTY WHITE DRUG
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 503 3RD AVE E SUITE 100
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City | ALEXANDRIA
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State | MN
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Zip | 56308-1503
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Country | US
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Telephone | 320-762-1534
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Fax | 320-763-7582
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Provider Business Mailing Address
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Address Line | 503 3RD AVE E SUITE 100
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City | ALEXANDRIA
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State | MN
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Zip | 56308-1503
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Country | US
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Telephone | 320-762-1534
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Fax | 320-763-7582
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | DR. BRIAN THOMAS GIBSON
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Credential |
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Telephone | 320-762-1534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 116035
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License Number State | MN
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