Provider Demographics
NPI:1205979978
Name:DRUG EXPRESS PHARMACIES INC
Entity type:Organization
Organization Name:DRUG EXPRESS PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:952-873-6220
Mailing Address - Street 1:613 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-2213
Mailing Address - Country:US
Mailing Address - Phone:952-873-6220
Mailing Address - Fax:952-873-3456
Practice Address - Street 1:613 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-2213
Practice Address - Country:US
Practice Address - Phone:952-873-6220
Practice Address - Fax:952-873-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2602713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2417168OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN580758100Medicaid