Healthcare Provider Details

I. General information

NPI: 1548627631
Provider Name (Legal Business Name): CROSBY DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAIN STREET NORTH
CROSBY ND
58730-0050
US

IV. Provider business mailing address

PO BOX 888 P.O. BOX 888
CROSBY ND
58730-0861
US

V. Phone/Fax

Practice location:
  • Phone: 701-965-6671
  • Fax: 701-965-6849
Mailing address:
  • Phone: 701-965-6671
  • Fax: 701-965-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR949
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL GRATZ
Title or Position: PARTNER/OWNER
Credential: PHARMD
Phone: 701-572-7979