Provider Demographics
NPI:1528081494
Name:RUSHFORD DRUG CO
Entity type:Organization
Organization Name:RUSHFORD DRUG CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES., CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:507-864-3238
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-0370
Mailing Address - Country:US
Mailing Address - Phone:507-864-3238
Mailing Address - Fax:507-864-4207
Practice Address - Street 1:115 W JESSIE ST
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-0370
Practice Address - Country:US
Practice Address - Phone:507-864-2153
Practice Address - Fax:507-864-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2613181333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN058602100Medicaid
2402484OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2402484OtherOTHER ID NUMBER-COMMERCIAL NUMBER