=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184728271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASTRUP DRUG INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 01/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 322 S STATE ST FIVE LAKES CTR
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56031-4139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-238-2797
-----------------------------------------------------
Fax | 507-238-4701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 N MAIN ST BOX 658
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55912-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-434-7428
-----------------------------------------------------
Fax | 507-433-1632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DISTRICT PHARMACY MANAGER
-----------------------------------------------------
Name | DAVID BROOKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-618-6340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 264421
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------