=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114409257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASTRUP DRUG, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2018
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MAIN ST S STE 115
-----------------------------------------------------
City | LE SUEUR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56058-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-665-3301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 N MAIN ST
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55912-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-433-7447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ASSISTANT
-----------------------------------------------------
Name | TINA MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-434-7425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------