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General NPI Number Information
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NPI Number | 1588770440
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Entity Type | Organization
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Legal Business Name | KILLDEER PHAMRACY INC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 713 EAST MAIN STREET
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City | NEW ENGLAND
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State | ND
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Zip | 58647
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Country | US
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Telephone | 701-579-4130
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Fax | 701-579-4899
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Provider Business Mailing Address
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Address Line | 713 EAST MAIN STREET
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City | NEW ENGLAND
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State | ND
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Zip | 58647
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Country | US
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Telephone | 701-579-4130
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Fax | 701-579-4899
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Authorized Official
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Title or Position | OWNER
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Name | MR. JODY A DOE
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Credential | RPH
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Telephone | 701-579-4130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 590
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License Number State | ND
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