Provider Demographics
NPI:1982952644
Name:GARRISON DRUG
Entity Type:Organization
Organization Name:GARRISON DRUG
Other - Org Name:GARRISON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHAMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-532-3633
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:MN
Mailing Address - Zip Code:56450-0425
Mailing Address - Country:US
Mailing Address - Phone:320-692-5858
Mailing Address - Fax:320-692-5859
Practice Address - Street 1:27378 STATE HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:MN
Practice Address - Zip Code:56450-8642
Practice Address - Country:US
Practice Address - Phone:320-692-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2627473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN588557400Medicaid
2431598OtherNCPDP PROVIDER IDENTIFICATION NUMBER