Healthcare Provider Details

I. General information

NPI: 1467611970
Provider Name (Legal Business Name): ELBOWOODS MEMORIAL HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 COLLEGE DR
NEW TOWN ND
58763-9112
US

IV. Provider business mailing address

1058 COLLEGE DR
NEW TOWN ND
58763-9112
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4750
  • Fax: 701-627-2815
Mailing address:
  • Phone: 701-627-4750
  • Fax: 701-627-2815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number619
License Number StateND

VIII. Authorized Official

Name: DONNA BIERI
Title or Position: CHIEF TELEPHARMACIST
Credential:
Phone: 701-938-3459