Provider Demographics
NPI:1760675755
Name:SEIP DRUG LLC
Entity type:Organization
Organization Name:SEIP DRUG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANG
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-640-2722
Mailing Address - Street 1:801 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1916
Mailing Address - Country:US
Mailing Address - Phone:218-233-1529
Mailing Address - Fax:218-233-8917
Practice Address - Street 1:801 CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-1916
Practice Address - Country:US
Practice Address - Phone:218-233-1529
Practice Address - Fax:218-233-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
MN2630743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN636930000Medicaid
2049250OtherPK