Healthcare Provider Details

I. General information

NPI: 1205923406
Provider Name (Legal Business Name): WESTERN DAKOTA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MAIN ST
WILLISTON ND
58801-4233
US

IV. Provider business mailing address

PO BOX 640
WILLISTON ND
58802-0640
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-7797
  • Fax: 701-572-0937
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number51
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GERALD GRATZ
Title or Position: PRESIDENT
Credential: RPH
Phone: 701-572-7797