Healthcare Provider Details

I. General information

NPI: 1255486908
Provider Name (Legal Business Name): ECONOMY DRUG MOTT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 BROWN AVE
MOTT ND
58646-7100
US

IV. Provider business mailing address

PO BOX 279 216 BROWN AVE
MOTT ND
58646
US

V. Phone/Fax

Practice location:
  • Phone: 701-824-8297
  • Fax:
Mailing address:
  • Phone: 701-824-2897
  • Fax: 701-824-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number552
License Number StateND

VIII. Authorized Official

Name: CHARLES OIEN
Title or Position: OWNER
Credential:
Phone: 701-824-2897