Healthcare Provider Details

I. General information

NPI: 1790889715
Provider Name (Legal Business Name): SANFORD BISMARCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 7TH ST
BISMARCK ND
58501
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6099
  • Fax: 701-323-5713
Mailing address:
  • Phone: 605-328-6585
  • Fax: 605-328-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR187A
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHAR187A
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR187
License Number StateND

VIII. Authorized Official

Name: TONY LEE MORRISON
Title or Position: VP, CHIEF REVENUE CYCLE OFFICER
Credential:
Phone: 605-328-8380