Healthcare Provider Details

I. General information

NPI: 1710024807
Provider Name (Legal Business Name): HAZEN DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAIN STREET
HAZEN ND
58545
US

IV. Provider business mailing address

30 MAIN STREET
HAZEN ND
58545
US

V. Phone/Fax

Practice location:
  • Phone: 701-748-2312
  • Fax: 701-748-2637
Mailing address:
  • Phone: 701-748-2312
  • Fax: 701-748-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number156
License Number StateND

VIII. Authorized Official

Name: MICHAEL R. CHASE
Title or Position: PRESIDENT
Credential: R.PH
Phone: 701-748-2312