Provider Demographics
NPI:1699195628
Name:WHITE DRUG ENTERPRISES, INC.
Entity Type:Organization
Organization Name:WHITE DRUG ENTERPRISES, INC.
Other - Org Name:THRIFTY WHITE PHARMACY #079
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROISTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-513-4377
Mailing Address - Street 1:6055 NATHAN LN N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:763-585-3507
Mailing Address - Fax:763-248-7581
Practice Address - Street 1:701 W ELM AVE
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1439
Practice Address - Country:US
Practice Address - Phone:712-335-3119
Practice Address - Fax:712-335-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
IA15033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1699195628Medicaid
2145660OtherPK
IA1699195628Medicaid
IB1448Medicare PIN