Healthcare Provider Details

I. General information

NPI: 1396871216
Provider Name (Legal Business Name): KENMARE DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 1ST AVE NW
KENMARE ND
58746-7165
US

IV. Provider business mailing address

PO BOX 895
KENMARE ND
58746-0895
US

V. Phone/Fax

Practice location:
  • Phone: 701-385-4257
  • Fax: 701-385-4258
Mailing address:
  • Phone: 701-385-4257
  • Fax: 701-385-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR49
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIM ESSLER
Title or Position: OWNER
Credential: RPH
Phone: 701-385-4257