Organization
JUDEAN INC
Active
Other names
LICHTY DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN LICHTY (PRESIDENT)
(507) 274-6114
Entity
Organization
Contact information
Practice address
601 1ST AVE, WESTBROOK, MN 56183
(507) 274-6114
(507) 274-5688
Mailing address
PO BOX 127, WESTBROOK, MN 56183-0127
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
260515
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2409173
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
932757600
—
MN
Enumeration date
09/21/2006
Last updated
03/20/2009
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