Provider Demographics
NPI:1922146836
Name:MERTENS DRUG INC
Entity Type:Organization
Organization Name:MERTENS DRUG INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MERTENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:218-631-2402
Mailing Address - Street 1:204 JEFFERSON ST N
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1371
Mailing Address - Country:US
Mailing Address - Phone:218-631-2402
Mailing Address - Fax:218-631-2723
Practice Address - Street 1:204 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1371
Practice Address - Country:US
Practice Address - Phone:218-631-2402
Practice Address - Fax:218-631-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26062533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2418920OtherNCPDP #
MNBM19995971OtherDEA #
MN5586420001Medicare NSC