Healthcare Provider Details

I. General information

NPI: 1013029024
Provider Name (Legal Business Name): CLINIC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 FAIRWAY ST
DICKINSON ND
58601-2590
US

IV. Provider business mailing address

2615 FAIRWAY ST
DICKINSON ND
58601-2590
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-4401
  • Fax: 701-483-4404
Mailing address:
  • Phone: 701-483-4401
  • Fax: 701-483-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR86
License Number StateND

VIII. Authorized Official

Name: BRANDI OLLERMAN
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 701-227-8265