1003906942 NPI number — WHITE DRUG CO OF JAMESTOWN INC

Table of content: (NPI 1003906942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003906942 NPI number — WHITE DRUG CO OF JAMESTOWN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE DRUG CO OF JAMESTOWN 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:
WHITE DRUG #61
Provider Other Organization Name Type Code:
3
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:
1003906942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6055 NATHAN LN N
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55442-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-513-4300
Provider Business Mailing Address Fax Number:
763-513-4380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 38TH ST N
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-893-9050
Provider Business Practice Location Address Fax Number:
701-893-9053
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FROISTAD
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSING COORDINATOR
Authorized Official Telephone Number:
763-513-4377

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  1409 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: A9-0001464 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PHNR001011 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: NRX0000521 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PCN.0002714 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 22-44533 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 27263 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 054.018687 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PMP-987 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: OSP.0006440 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: NRP1463 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: ND1839 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 3722 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 64001649A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 35705MS , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 924692000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1460158 DME , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1455652 RX , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2071512 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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