Provider Demographics
NPI:1588606016
Name:CANBY DRUG & GIFTS INC
Entity Type:Organization
Organization Name:CANBY DRUG & GIFTS INC
Other - Org Name:CANBY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:WHITTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-829-4169
Mailing Address - Street 1:130 ST. OLAF AVE N
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:MN
Mailing Address - Zip Code:56220
Mailing Address - Country:US
Mailing Address - Phone:507-223-5955
Mailing Address - Fax:507-223-5696
Practice Address - Street 1:130 ST. OLAF AVE N
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220
Practice Address - Country:US
Practice Address - Phone:507-223-5955
Practice Address - Fax:507-223-5696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
MN2606593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN095860300Medicaid
SD8532830Medicaid
2046653OtherPK
MN095860300Medicaid