Provider Demographics
NPI:1467510586
Name:PELICAN DRUG INC
Entity Type:Organization
Organization Name:PELICAN DRUG INC
Other - Org Name:PELICAN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:218-863-1441
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:PELICAN RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56572-0621
Mailing Address - Country:US
Mailing Address - Phone:218-863-1441
Mailing Address - Fax:
Practice Address - Street 1:11 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572-4138
Practice Address - Country:US
Practice Address - Phone:218-863-1441
Practice Address - Fax:218-863-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MN2599883336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045050OtherPK
MN516757400Medicaid
0236270001Medicare NSC