Healthcare Provider Details

I. General information

NPI: 1891808523
Provider Name (Legal Business Name): NEUMANN REXALL DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MAIN STREET
CANDO ND
58324-0459
US

IV. Provider business mailing address

PO BOX 459
CANDO ND
58324-0459
US

V. Phone/Fax

Practice location:
  • Phone: 701-968-3531
  • Fax: 701-968-3560
Mailing address:
  • Phone: 701-968-3531
  • Fax: 701-968-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2965
License Number StateND

VIII. Authorized Official

Name: MR. ROGER LEROY NARVESON
Title or Position: PHARMACIST
Credential:
Phone: 701-968-3531