Provider Demographics
NPI:1447261953
Name:OLIVIA DRUG COMPANY
Entity type:Organization
Organization Name:OLIVIA DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-523-1630
Mailing Address - Street 1:102 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1328
Mailing Address - Country:US
Mailing Address - Phone:320-523-1630
Mailing Address - Fax:320-523-1680
Practice Address - Street 1:102 9TH ST S
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1328
Practice Address - Country:US
Practice Address - Phone:320-523-1630
Practice Address - Fax:320-523-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2054753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045040OtherPK
MN645557300Medicaid
0194190001Medicare NSC