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: 08/27/2025
Certification Date: 08/20/2025
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 TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
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 Number717
License Number StateND

VII. Legacy identifiers

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

# 1
Identifier1464337
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

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