Provider Demographics
NPI:1053647867
Name:RUSHFORD DRUG CO
Entity Type:Organization
Organization Name:RUSHFORD DRUG CO
Other - Org Name:WITT'S PHARMACY - LACRESCENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-421-2993
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-0370
Mailing Address - Country:US
Mailing Address - Phone:507-864-3238
Mailing Address - Fax:507-864-4207
Practice Address - Street 1:306 MAIN ST # 103
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1828
Practice Address - Country:US
Practice Address - Phone:507-895-8784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2634403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2429911OtherNCPDP PROVIDER IDENTIFICATION NUMBER