Provider Demographics
NPI:1174661169
Name:CALEDONIA DRUGS
Entity Type:Organization
Organization Name:CALEDONIA DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYGVE SIME
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:507-725-5241
Mailing Address - Street 1:210 S KINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55921-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 S KINGSTON ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MN
Practice Address - Zip Code:55921-1316
Practice Address - Country:US
Practice Address - Phone:507-725-5241
Practice Address - Fax:507-725-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2054177333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2403979OtherOTHER ID NUMBER-COMMERCIAL NUMBER