Healthcare Provider Details

I. General information

NPI: 1568485431
Provider Name (Legal Business Name): SEARS ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 LINCOLN AVE
HARVEY ND
58341-1520
US

IV. Provider business mailing address

722 LINCOLN AVE
HARVEY ND
58341-1520
US

V. Phone/Fax

Practice location:
  • Phone: 701-324-2295
  • Fax:
Mailing address:
  • Phone: 701-324-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number216
License Number StateND

VIII. Authorized Official

Name: JOHN R SEARS
Title or Position: OWNER
Credential:
Phone: 701-324-2295