Healthcare Provider Details

I. General information

NPI: 1215371695
Provider Name (Legal Business Name): ECONOMY DRUG MOTT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 BROWN AVE
MOTT ND
58646-0279
US

IV. Provider business mailing address

PO BOX 279 216 BROWN AVE
MOTT ND
58646-0279
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR552
License Number StateND

VIII. Authorized Official

Name: DR. CHARLES WAYNE OIEN
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 701-824-2897