Healthcare Provider Details

I. General information

NPI: 1922019686
Provider Name (Legal Business Name): J & J ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MAIN ST SW
DUNSEITH ND
58329-0729
US

IV. Provider business mailing address

PO BOX 729
DUNSEITH ND
58329-0729
US

V. Phone/Fax

Practice location:
  • Phone: 701-244-5212
  • Fax: 701-244-2242
Mailing address:
  • Phone: 701-244-5212
  • Fax: 701-244-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number133
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier21115
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 2
Identifier3504265
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP

VIII. Authorized Official

Name: MRS. LAURIE ANN THOMPSON
Title or Position: OWNER
Credential: RPH
Phone: 701-244-5212