Healthcare Provider Details

I. General information

NPI: 1386664829
Provider Name (Legal Business Name): LINSON PHARMACY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 25TH ST S
FARGO ND
58103-6171
US

IV. Provider business mailing address

3175 25TH ST S
FARGO ND
58103-6171
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-6022
  • Fax: 701-293-6040
Mailing address:
  • Phone: 701-293-6022
  • Fax: 701-293-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHAR6
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number261023
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE BOEHNING
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 701-293-6022