Healthcare Provider Details

I. General information

NPI: 1063690774
Provider Name (Legal Business Name): PHARMACISTS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN STREET
NORTHWOOD ND
58267-0399
US

IV. Provider business mailing address

PO BOX 399
NORTHWOOD ND
58267-0399
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-5271
  • Fax: 701-587-6091
Mailing address:
  • Phone: 701-587-5271
  • Fax: 701-587-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. LYLE LYNN LUTMAN
Title or Position: PARTNER
Credential:
Phone: 701-256-3330