Provider Demographics
NPI:1972502102
Name:KROON COMMUNITY DRUG INC
Entity Type:Organization
Organization Name:KROON COMMUNITY DRUG INC
Other - Org Name:KROON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-483-2679
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110-0070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 MAINE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MN
Practice Address - Zip Code:56110-0070
Practice Address - Country:US
Practice Address - Phone:507-483-2679
Practice Address - Fax:507-483-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2605353336C0003X
3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2414869OtherOTHER ID NUMBER
MN074860900Medicaid
0161020001Medicare NSC