Healthcare Provider Details

I. General information

NPI: 1407038532
Provider Name (Legal Business Name): LG MEADOWS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W VILLARD ST
DICKINSON ND
58601-5016
US

IV. Provider business mailing address

431 W VILLARD ST
DICKINSON ND
58601-5016
US

V. Phone/Fax

Practice location:
  • Phone: 701-227-8265
  • Fax: 701-227-8289
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateND

VIII. Authorized Official

Name: MR. LAREN G MEADOWS
Title or Position: OWNER
Credential: RPH
Phone: 701-227-8265