Provider Demographics
NPI:1770672388
Name:WHITE DRUG ENTERPRISES INC
Entity Type:Organization
Organization Name:WHITE DRUG ENTERPRISES INC
Other - Org Name:WHITE DRUG #25
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:763-513-4300
Mailing Address - Fax:763-513-4380
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4633
Practice Address - Country:US
Practice Address - Phone:406-482-1420
Practice Address - Fax:406-482-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MT5483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT229502Medicaid
2050000OtherPK
MT562497 SUPPLYMedicaid
MT229502Medicaid
2050000OtherPK