Provider Demographics
NPI:1093923914
Name:SEIP DRUG LLC
Entity Type:Organization
Organization Name:SEIP DRUG LLC
Other - Org Name:SEIP PRESCRIPTION SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANG RPH
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-385-3360
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-0098
Mailing Address - Country:US
Mailing Address - Phone:218-385-3360
Mailing Address - Fax:218-346-3370
Practice Address - Street 1:415 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1264
Practice Address - Country:US
Practice Address - Phone:218-632-5440
Practice Address - Fax:218-632-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MN2630463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN551430000Medicaid
2049242OtherPK