1396834909 NPI number — WHITE DRUG CO OF JAMESTOWN INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396834909 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 #47 DBA BELL DRUG
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:
1396834909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2021
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 STE 200
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:
55442-1675
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:
323 5TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-2476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-3022
Provider Business Practice Location Address Fax Number:
701-662-2042
Provider Enumeration Date:
10/12/2006

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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHAR374 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1396834909 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1455574 RX , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2071484 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1455832 DME , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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