=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588753198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAYLOR DRUG CO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 OVERLOOK LN NW
-----------------------------------------------------
City | MANDAN
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58554-1594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-663-5188
-----------------------------------------------------
Fax | 701-663-1880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6701 EVENSTAD DR N STE 100
-----------------------------------------------------
City | MAPLE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55369-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-513-4300
-----------------------------------------------------
Fax | 763-513-4380
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSING COORDINATOR
-----------------------------------------------------
Name | ANNE FROISTAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-513-4377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHAR3
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------