Healthcare Provider Details

I. General information

NPI: 1780699314
Provider Name (Legal Business Name): TURTLE LAKE REXALL DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MAIN
TURTLE LAKE ND
58575
US

IV. Provider business mailing address

PO BOX 70
TURTLE LAKE ND
58575-0070
US

V. Phone/Fax

Practice location:
  • Phone: 701-448-2542
  • Fax: 701-448-2357
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number185
License Number StateND

VIII. Authorized Official

Name: MARK MALZER
Title or Position: OWNER
Credential: RPH
Phone: 701-448-2542