Healthcare Provider Details

I. General information

NPI: 1568541233
Provider Name (Legal Business Name): DAKOTA PRECISION RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E MAIN AVE STE 200
BISMARCK ND
58501-4525
US

IV. Provider business mailing address

705 E MAIN AVE STE 200
BISMARCK ND
58501-4525
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-1881
  • Fax: 701-255-7226
Mailing address:
  • Phone: 701-255-1881
  • Fax: 701-255-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHAR428
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier21433
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 2
Identifier2071516
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: ANTON WELDER
Title or Position: PRES OWNER
Credential: RPH
Phone: 701-255-1881