Provider Demographics
NPI:1255841193
Name:ASTRUP DRUG INC
Entity Type:Organization
Organization Name:ASTRUP DRUG INC
Other - Org Name:STERLING LTC #36
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRACT PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-796-0097
Mailing Address - Street 1:1312 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1140
Mailing Address - Country:US
Mailing Address - Phone:888-341-1542
Mailing Address - Fax:507-697-0082
Practice Address - Street 1:1312 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1140
Practice Address - Country:US
Practice Address - Phone:651-412-5939
Practice Address - Fax:651-412-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MN2654203336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1255841193Medicaid
2172151OtherPK