Provider Demographics
NPI:1871503722
Name:SEIP DRUG LLC
Entity Type:Organization
Organization Name:SEIP DRUG LLC
Other - Org Name:SEIP DRUG #10
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-640-2722
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:BERTHA
Mailing Address - State:MN
Mailing Address - Zip Code:56437-0157
Mailing Address - Country:US
Mailing Address - Phone:218-849-2124
Mailing Address - Fax:218-849-2129
Practice Address - Street 1:124 2ND AVE WEST
Practice Address - Street 2:
Practice Address - City:BERTHA
Practice Address - State:MN
Practice Address - Zip Code:56437
Practice Address - Country:US
Practice Address - Phone:218-924-2124
Practice Address - Fax:218-924-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MN2635233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1871503722Medicaid
2125113OtherPK