Provider Demographics
NPI:1437161023
Name:J & R REXALL DRUG
Entity Type:Organization
Organization Name:J & R REXALL DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-235-9719
Mailing Address - Street 1:107 DOWNTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-1726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 DOWNTOWN PLZ
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-1726
Practice Address - Country:US
Practice Address - Phone:507-235-9719
Practice Address - Fax:507-235-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN20494123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN384757800Medicaid
2402701OtherOTHER ID NUMBER
MN384757800Medicaid