Healthcare Provider Details

I. General information

NPI: 1235140898
Provider Name (Legal Business Name): ROLLA DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MAIN AVE E
ROLLA ND
58367-7124
US

IV. Provider business mailing address

PO BOX 819
ROLLA ND
58367-0819
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-3174
  • Fax: 701-477-3378
Mailing address:
  • Phone: 701-477-3174
  • Fax: 701-477-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR120
License Number StateND

VIII. Authorized Official

Name: STEVEN MCATEE
Title or Position: PIC
Credential: REG.PHARM.
Phone: 701-477-3174