Healthcare Provider Details

I. General information

NPI: 1023107638
Provider Name (Legal Business Name): WHITE DRUG CO OF JAMESTOWN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MAIN ST
VALLEY CITY ND
58072-3319
US

IV. Provider business mailing address

6701 EVENSTAD DR N STE 100
MAPLE GROVE MN
55369-6013
US

V. Phone/Fax

Practice location:
  • Phone: 701-845-1763
  • Fax: 701-845-5171
Mailing address:
  • Phone: 763-513-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR600
License Number StateND

VIII. Authorized Official

Name: ANNE FROISTAD
Title or Position: LICENSING COORDINATOR
Credential:
Phone: 763-513-4377