Provider Demographics
NPI:1558306753
Name:HERRMANN DRUG INC
Entity Type:Organization
Organization Name:HERRMANN DRUG INC
Other - Org Name:HERRMANN THRIFTY WHITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:RABENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-364-7717
Mailing Address - Street 1:120 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:MN
Mailing Address - Zip Code:56069-1645
Mailing Address - Country:US
Mailing Address - Phone:507-364-7717
Mailing Address - Fax:507-364-5275
Practice Address - Street 1:120 1ST ST S
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:MN
Practice Address - Zip Code:56069-1645
Practice Address - Country:US
Practice Address - Phone:507-364-7717
Practice Address - Fax:507-364-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2616433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN778558500Medicaid
2044945OtherPK
2044945OtherPK