Provider Demographics
NPI:1477667467
Name:DAS PHARMACEUTICAL SERVICES INC
Entity Type:Organization
Organization Name:DAS PHARMACEUTICAL SERVICES INC
Other - Org Name:SAMUELSON DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:320-239-2246
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-0399
Mailing Address - Country:US
Mailing Address - Phone:320-239-2246
Mailing Address - Fax:320-239-2296
Practice Address - Street 1:118 W 5TH ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-2426
Practice Address - Country:US
Practice Address - Phone:320-239-2246
Practice Address - Fax:320-239-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MN2632863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045081OtherPK