Provider Demographics
NPI:1992833198
Name:SEIP DRUG LLC
Entity Type:Organization
Organization Name:SEIP DRUG LLC
Other - Org Name:SEIP DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MNGR
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 304
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:MN
Mailing Address - Zip Code:56551-0304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551-4000
Practice Address - Country:US
Practice Address - Phone:218-583-2773
Practice Address - Fax:218-583-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336M0002X
MN2629693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND213955EMedicaid
MN785725000Medicaid
2047365OtherPK
ND213955EMedicaid