Provider Demographics
NPI:1144424177
Name:SEIP DRUG LLC
Entity Type:Organization
Organization Name:SEIP DRUG LLC
Other - Org Name:SEIP DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANG
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:218-640-2722
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:218-385-4535
Practice Address - Street 1:113 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515-0538
Practice Address - Country:US
Practice Address - Phone:218-864-5261
Practice Address - Fax:218-864-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2630353336C0003X
3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN723463000Medicaid
2428351OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN723463000Medicaid