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General NPI Number Information
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NPI Number | 1245302900
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Entity Type | Organization
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Legal Business Name | ANDERSON DRUG INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 509 MAIN ST
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City | EDGELEY
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State | ND
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Zip | 58433
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Country | US
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Telephone | 701-493-2810
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Fax | 701-493-2641
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Provider Business Mailing Address
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Address Line | PO BOX 405 509 MAIN ST
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City | EDGELEY
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State | ND
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Zip | 58433
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Country | US
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Telephone | 701-493-2810
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Fax | 701-493-2641
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Authorized Official
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Title or Position | PRES RPH
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Name | MR. JOHN RICHARD BERINGER
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Credential | RPH
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Telephone | 701-493-2810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 94
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License Number State | ND
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