Provider Demographics
NPI:1528148525
Name:CROSSTOWN DRUG
Entity type:Organization
Organization Name:CROSSTOWN DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-780-1500
Mailing Address - Street 1:8400 CORAL SEA ST, SUITE 525
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4398
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8400 CORAL SEA ST, SUITE 525
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112-4398
Practice Address - Country:US
Practice Address - Phone:763-780-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN259796-4333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2414693OtherNCPDP
MN116057500Medicaid
MN2414693OtherNCPDP