MEDICARE: CHISAGO DRUG

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	333600000X	Pharmacy	2598947	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619978913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHISAGO DRUG

Provider Business Mailing Address
First Line	:	PO BOX 603
Second Line	:
City	:	CHISAGO CITY
State	:	MN
Zip	:	55013-0603
Country	:	US
Telephone Number	:	651-257-4950
Fax Number	:	651-213-3222

Provider Business Practice Location Address
First Line	:	10655 RAILROAD AVE
Second Line	:
City	:	CHISAGO CITY
State	:	MN
Zip	:	55013-9442
Country	:	US
Telephone Number	:	651-257-4950
Fax Number	:	651-213-3222

Authorized Official
Title or Position	:	PHARMACIST OWNER
Name	:	CHARLES M GRAMLING
Credential	:	R.PH.
Telephone Number	:	651-257-4950

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	09/04/2009

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Directions to “CHISAGO DRUG ” Practice Location

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