Healthcare Provider Details

I. General information

NPI: 1548566698
Provider Name (Legal Business Name): EDGELEY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MAIN ST STE B
EDGELEY ND
58433-7119
US

IV. Provider business mailing address

PO BOX 25
EDGELEY ND
58433-0025
US

V. Phone/Fax

Practice location:
  • Phone: 701-493-2810
  • Fax: 701-493-2263
Mailing address:
  • Phone: 701-493-2810
  • Fax: 701-493-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number717
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL MOORE CHURCHILL
Title or Position: PRESIDENT
Credential: PHARM. D.
Phone: 701-224-0339