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General NPI Number Information
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NPI Number | 1710977897
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Entity Type | Organization
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Legal Business Name | SOUTHTOWN ECONODRUG, INC.
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 387 11TH ST S
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City | WAHPETON
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State | ND
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Zip | 58075-4653
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Country | US
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Telephone | 701-642-2336
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Fax | 701-642-1470
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Provider Business Mailing Address
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Address Line | 387 11TH ST S
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City | WAHPETON
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State | ND
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Zip | 58075-4653
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Country | US
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Telephone | 701-642-2336
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Fax | 701-642-1470
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAULA L. MCDONALD
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Credential | R.PH
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Telephone | 701-642-2336
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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 | 152
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License Number State | ND
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