1336237346 NPI number — WAHPETON DRUG COMPANY INC

Table of content: (NPI 1336237346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336237346 NPI number — WAHPETON DRUG COMPANY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAHPETON DRUG COMPANY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336237346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 DAKOTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAHPETON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58075-4415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-642-9211
Provider Business Mailing Address Fax Number:
701-642-5946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 DAKOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-9211
Provider Business Practice Location Address Fax Number:
701-642-5946
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRAUS
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
701-642-9211

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 54 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 82134900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8530860 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0214183 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21101 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100252451-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 748260400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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