Provider Demographics
NPI:1740385178
Name:ASTRUP DRUG INC
Entity Type:Organization
Organization Name:ASTRUP DRUG INC
Other - Org Name:STERLING DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-618-6340
Mailing Address - Street 1:905 N MAIN ST
Mailing Address - Street 2:BOX 658
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3357
Mailing Address - Country:US
Mailing Address - Phone:507-434-7428
Mailing Address - Fax:507-433-1632
Practice Address - Street 1:511 10TH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2342
Practice Address - Country:US
Practice Address - Phone:507-372-7533
Practice Address - Fax:507-372-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2644253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1740385178Medicaid
2046084OtherPK
MN1740385178Medicaid