Provider Demographics
NPI:1427101112
Name:ASTRUP DRUG, INC
Entity type:Organization
Organization Name:ASTRUP DRUG, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-433-7447
Mailing Address - Street 1:905 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3557
Mailing Address - Country:US
Mailing Address - Phone:507-434-7425
Mailing Address - Fax:507-433-1632
Practice Address - Street 1:223 S LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1642
Practice Address - Country:US
Practice Address - Phone:651-345-3411
Practice Address - Fax:651-345-4848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASTRUP DRUG, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260316-2183500000X
MN260316310400000X, 313M00000X, 314000000X
311ZA0620X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care FacilityGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN421758600Medicaid