Healthcare Provider Details

I. General information

NPI: 1043243272
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 COLORADO LANE #400
BISMARCK ND
58503
US

IV. Provider business mailing address

3124 COLORADO LN STE 400
BISMARCK ND
58503-5446
US

V. Phone/Fax

Practice location:
  • Phone: 701-223-6854
  • Fax: 701-223-6856
Mailing address:
  • Phone: 701-223-6854
  • Fax: 877-790-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number624
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number624
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number624
License Number StateND

VIII. Authorized Official

Name: DR. DANIEL MOORE CHURCHILL
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 701-224-0339