Healthcare Provider Details

I. General information

NPI: 1649329632
Provider Name (Legal Business Name): NORTH DAKOTA DOCR PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 RAILROAD AVENUE
BISMARCK ND
58506-5521
US

IV. Provider business mailing address

PO BOX 5521 3100 RAILROAD AVENUE
BISMARCK ND
58506-5521
US

V. Phone/Fax

Practice location:
  • Phone: 701-328-6389
  • Fax: 701-328-6391
Mailing address:
  • Phone: 701-328-6389
  • Fax: 701-328-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3397
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH P JOHNSON
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 701-328-6389