Provider Demographics
NPI:1033521109
Name:WHITE DRUG ENTERPRISES INC
Entity Type:Organization
Organization Name:WHITE DRUG ENTERPRISES INC
Other - Org Name:THRIFTY WHITE PHARMACY #080
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROISTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-513-4377
Mailing Address - Street 1:6055 NATHAN LN N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:763-513-4388
Mailing Address - Fax:763-248-7581
Practice Address - Street 1:2720 S 163RD ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3610
Practice Address - Country:US
Practice Address - Phone:262-780-1910
Practice Address - Fax:262-780-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
WI9265-423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033521109Medicaid
2145927OtherPK
2145927OtherPK