Healthcare Provider Details

I. General information

NPI: 1639254113
Provider Name (Legal Business Name): PRESCRIPTION CENTER PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 13TH AVE S
FARGO ND
58103-3602
US

IV. Provider business mailing address

2701 13TH AVE S
FARGO ND
58103-3602
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3630
  • Fax: 701-234-3631
Mailing address:
  • Phone: 701-234-3630
  • Fax: 701-234-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number02
License Number StateND

VIII. Authorized Official

Name: JEFFREY DOUGLAS JACOBSON
Title or Position: PRESIDENT
Credential:
Phone: 701-234-9912