Provider Demographics
NPI:1568532299
Name:RUSHFORD DRUG CO
Entity Type:Organization
Organization Name:RUSHFORD DRUG CO
Other - Org Name:WITT'S PHARMACY - HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:507-864-3238
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55943-0477
Mailing Address - Country:US
Mailing Address - Phone:507-896-4505
Mailing Address - Fax:507-896-4506
Practice Address - Street 1:119 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MN
Practice Address - Zip Code:55943-8619
Practice Address - Country:US
Practice Address - Phone:507-896-4505
Practice Address - Fax:507-896-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114628-0183500000X
332B00000X
MN261934-73336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN168460400Medicaid
1068630005Medicare NSC