Provider Demographics
NPI:1063506475
Name:ASTRUP DRUG, INC
Entity type:Organization
Organization Name:ASTRUP DRUG, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR CONTRACTING & LICENSING SPEC
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-433-7447
Mailing Address - Street 1:1109 W OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2245
Mailing Address - Country:US
Mailing Address - Phone:507-433-7123
Mailing Address - Fax:507-433-1201
Practice Address - Street 1:1109 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2245
Practice Address - Country:US
Practice Address - Phone:507-433-7123
Practice Address - Fax:507-433-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2614407333600000X
3336L0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2422246OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA1063506475Medicaid
MN297516500Medicaid
MNBM5534070OtherDEA #
2422246OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA1063506475Medicaid
MN870000792Medicare PIN