Healthcare Provider Details

I. General information

NPI: 1578588307
Provider Name (Legal Business Name): WISHEK DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 S CENTENNIAL ST
WISHEK ND
58495-7216
US

IV. Provider business mailing address

PO BOX 217
WISHEK ND
58495-0217
US

V. Phone/Fax

Practice location:
  • Phone: 701-452-2368
  • Fax: 701-452-2399
Mailing address:
  • Phone: 701-454-2236
  • Fax: 701-452-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number493
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CARLA AIPPERSPACH
Title or Position: OWNER
Credential: RPH
Phone: 701-452-2368