Healthcare Provider Details

I. General information

NPI: 1710056452
Provider Name (Legal Business Name): NEW SALEM PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/02/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 ASH AVE
NEW SALEM ND
58563-4501
US

IV. Provider business mailing address

PO BOX H
NEW SALEM ND
58563-0426
US

V. Phone/Fax

Practice location:
  • Phone: 701-843-7563
  • Fax: 701-843-7564
Mailing address:
  • Phone: 701-843-7563
  • Fax: 701-843-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR768
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL CHURCHILL
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 701-224-0339