NPIMap

Organization Active NPI

Duesterberg Drug Co Inc

  • Community/Retail Pharmacy
  • Vincennes, IN
National Provider Identifier
1104896752
Registry record updated Dec 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60000728A Issued in IN
Legal business name
DUESTERBERG DRUG CO INC
Practice address
402 S 6TH St
Vincennes, IN 47591-1023
Phone
(812) 882-6193
Fax
(812) 882-6186
NPI assigned
Jan 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Clifton Cleveland, RPHNPI 1558331199
Title
Owner
Phone
(812) 882-6193

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 60000728A IN Primary

Addresses

Primary practice location

402 S 6TH St
Vincennes, IN 47591-1023

Mailing address

PO Box 116
Vincennes, IN 47591-0116
Phone (812) 882-6193

Other identifiers 2

IdentifierTypeStateIssuer
100309350MedicaidIN
1514454OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • DUESTERBERG DRUG CO INC Doing business as

National Provider Directory

National Provider Directory

Locations

402 S 6th St
Vincennes, IN 47591
Phone (812) 882-6193

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261180800000",
    "number": "1104896752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475910116",
            "telephone_number": "812-882-6193",
            "fax_number": "812-882-6186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S 6TH ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911023",
            "telephone_number": "812-882-6193",
            "fax_number": "812-882-6186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUESTERBERG DRUG CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2009-12-19",
        "status": "A",
        "authorized_official_last_name": "CLEVELAND",
        "authorized_official_first_name": "CLIFTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-882-6193",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60000728A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100309350",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1514454",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DUESTERBERG DRUG CO INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vincennes, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.