MEDICARE: WHITE DRUG ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	291U00000X	Clinical Medical Laboratory
3	332B00000X	Durable Medical Equipment & Medical Supplies	PHAR464	ND
4	333600000X	Pharmacy
5	3336C0003X	Community/Retail Pharmacy	260285	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2045978	OTHER	PK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235229162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE DRUG ENTERPRISES INC

Provider Business Mailing Address
First Line	:	6701 EVENSTAD DR N STE 100
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-6013
Country	:	US
Telephone Number	:	763-513-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 S 2ND AVE
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2614
Country	:	US
Telephone Number	:	218-749-6333
Fax Number	:	218-749-2731

Authorized Official
Title or Position	:	LICENSING COORDINATOR
Name	:	ANNE FROISTAD
Credential	:
Telephone Number	:	763-513-4377

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	10/29/2024

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Directions to “WHITE DRUG ENTERPRISES INC ” Practice Location

Language	Start Address	Practice Location

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