Provider Demographics
NPI:1326353160
Name:SEIP DRUG LLC
Entity Type:Organization
Organization Name:SEIP DRUG LLC
Other - Org Name:SEIP DRUG #11
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
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:218-640-2722
Mailing Address - Street 1:320 MN HIGHWAY 78 N
Mailing Address - Street 2:PO BOX 154
Mailing Address - City:OTTERTAIL
Mailing Address - State:MN
Mailing Address - Zip Code:56571-7016
Mailing Address - Country:US
Mailing Address - Phone:218-367-2196
Mailing Address - Fax:218-367-2197
Practice Address - Street 1:320 MN HIGHWAY 78 N
Practice Address - Street 2:
Practice Address - City:OTTERTAIL
Practice Address - State:MN
Practice Address - Zip Code:56571-7016
Practice Address - Country:US
Practice Address - Phone:218-367-2196
Practice Address - Fax:218-367-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336M0002X
MN2635753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1326353160Medicaid
2126413OtherPK