=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518772029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUMM DRUG, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2025
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 4TH AVE SE
-----------------------------------------------------
City | GLENWOOD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56334-1879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-634-4434
-----------------------------------------------------
Fax | 320-634-5632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 198
-----------------------------------------------------
City | GLENWOOD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56334-0198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-634-4434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | CAITLIN PEDERSON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 320-634-4434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------