Healthcare Provider Details

I. General information

NPI: 1558379248
Provider Name (Legal Business Name): PHARMACISTS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BURRELL AVE SE
COOPERSTOWN ND
58425-0627
US

IV. Provider business mailing address

901 BURREL AVE SE
COOPERSTOWN ND
58425-0627
US

V. Phone/Fax

Practice location:
  • Phone: 701-797-2414
  • Fax: 701-797-3456
Mailing address:
  • Phone: 701-797-2414
  • Fax: 701-797-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR935
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR935
License Number StateND

VIII. Authorized Official

Name: MRS. SARAH RESSLER
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 701-797-2414