Healthcare Provider Details

I. General information

NPI: 1770698714
Provider Name (Legal Business Name): DAKOTA DRUG COMPANY OF STANLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S MAIN ST
STANLEY ND
58784-4003
US

IV. Provider business mailing address

107 S MAIN ST PO BOX 460
STANLEY ND
58784-4003
US

V. Phone/Fax

Practice location:
  • Phone: 701-628-2255
  • Fax: 701-628-2396
Mailing address:
  • Phone: 701-628-2255
  • Fax: 701-628-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR27
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2122398
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier1458601
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: TERRY DICK
Title or Position: RPH,VP
Credential: BS
Phone: 701-628-2255