NPIMap

Organization Active NPI

Astrup Drug, Inc

Doing business as Kennedy Drug

  • Community/Retail Pharmacy
  • Lake City, MN
National Provider Identifier
1427101112
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ASTRUP DRUG, INC
Doing business as
Kennedy Drug
Practice address
223 S Lakeshore Dr
Lake City, MN 55041-1642
Phone
(651) 345-3411
Fax
(651) 345-4848
NPI assigned
Jan 18, 2007
Last updated
Jun 18, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
ASTRUP DRUG, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

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

Authorized official

Name
Dan Astrup
Title
Owner
Phone
(507) 433-7447

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 260316 MN
Adult Care Home Facility 311ZA0620X NU
Nursing Facility/Intermediate Care Facility 313M00000X 260316 MN
Skilled Nursing Facility 314000000X 260316 MN
Pharmacist 183500000X 260316-2 MN
Community/Retail Pharmacy 3336C0003X NU Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

223 S Lakeshore Dr
Lake City, MN 55041-1642

Mailing address

905 N Main St
Austin, MN 55912-3557
Phone (507) 434-7425

Other identifiers 1

IdentifierTypeStateIssuer
421758600MedicaidMN

Other names 1

  • Kennedy Drug Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20190702001084 MN Part B Supplier - Pharmacy 7810993623 Practice locations: Lake City, MN
O20190702001414 MN Part B Supplier - Mass Immunization (Roster Biller Only) 7810993623 Practice locations: Lake City, MN
O20190814002959 MN DME Supplier - Pharmacy 7810993623 Practice locations: Lake City, MN

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Clancys Main Street40 organizations share this tax ID, including this one
Part of
Clancys Main Street

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Locations

223 S Lakeshore Dr
Lake City, MN 55041
Phone (651) 345-3411

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560816000000",
    "number": "1427101112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 N MAIN ST",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559123557",
            "telephone_number": "507-434-7425",
            "fax_number": "507-433-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 S LAKESHORE DR",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411642",
            "telephone_number": "651-345-3411",
            "fax_number": "651-345-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASTRUP DRUG, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ASTRUP DRUG, INC",
        "enumeration_date": "2007-01-18",
        "last_updated": "2019-06-18",
        "status": "A",
        "authorized_official_last_name": "ASTRUP",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-433-7447"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "260316",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MN",
            "license": "260316",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "260316",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "260316-2",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421758600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.