Provider Demographics
NPI:1659441384
Name:RUSHFORD DRUG COMPANY
Entity Type:Organization
Organization Name:RUSHFORD DRUG COMPANY
Other - Org Name:WITT'S PHARMACY - LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES., 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 370
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-8837
Mailing Address - Country:US
Mailing Address - Phone:507-864-3238
Mailing Address - Fax:507-864-4207
Practice Address - Street 1:120 W JESSIE ST
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-8837
Practice Address - Country:US
Practice Address - Phone:507-864-3238
Practice Address - Fax:507-864-4207
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSHFORD DRUG COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MN2624163336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN672680100Medicaid
1068630004Medicare NSC