Healthcare Provider Details

I. General information

NPI: 1447500566
Provider Name (Legal Business Name): ST. ALEXIUS MEDICAL CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58506-5510
US

IV. Provider business mailing address

900 E BROADWAY AVE
BISMARCK ND
58506-5510
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-6922
  • Fax: 701-530-6948
Mailing address:
  • Phone: 701-530-6922
  • Fax: 701-530-6948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number190
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number190
License Number StateND

VIII. Authorized Official

Name: MR. GARY MILLER
Title or Position: CEO
Credential:
Phone: 701-530-7610