Healthcare Provider Details

I. General information

NPI: 1588724728
Provider Name (Legal Business Name): METRO DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BROADWAY N
FARGO ND
58102-4925
US

IV. Provider business mailing address

123 BROADWAY N
FARGO ND
58102-4925
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-6150
  • Fax: 701-232-5216
Mailing address:
  • Phone: 701-232-6150
  • Fax: 701-232-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number87
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD NELSON
Title or Position: OWNER
Credential: RPH
Phone: 701-232-6150