Healthcare Provider Details

I. General information

NPI: 1376646315
Provider Name (Legal Business Name): VELVA DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N. MAIN ST
VELVA ND
58790
US

IV. Provider business mailing address

PO BOX 10
VELVA ND
58790-0010
US

V. Phone/Fax

Practice location:
  • Phone: 701-441-7511
  • Fax: 877-840-9428
Mailing address:
  • Phone: 701-338-2911
  • Fax: 701-338-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number523
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateND

VIII. Authorized Official

Name: MR. TRACY KRUEGER
Title or Position: PHARMACIST
Credential:
Phone: 701-441-7511