Healthcare Provider Details

I. General information

NPI: 1093134017
Provider Name (Legal Business Name): ST. ALEXIUS MANDAN PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SUNSET DRIVE NW, SUITE 2
MANDAN ND
58554
US

IV. Provider business mailing address

2500 SUNSET DRIVE NW, SUITE 2
MANDAN ND
58554
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-3750
  • Fax: 701-530-3788
Mailing address:
  • Phone: 701-530-3750
  • Fax: 701-530-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number793
License Number StateND

VIII. Authorized Official

Name: KRISTEN SPERLE
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 701-214-1868