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General NPI Number Information
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NPI Number | 1790795987
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Entity Type | Organization
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Legal Business Name | JACKSON DODDS INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 145 N MAIN ST
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City | WATFORD CITY
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State | ND
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Zip | 58854-7101
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Country | US
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Telephone | 701-842-3311
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Fax | 701-842-3310
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Provider Business Mailing Address
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Address Line | 145 N MAIN ST PO BOX 783
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City | WATFORD CITY
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State | ND
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Zip | 58854-7101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | JEFFREY DODDS
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Credential | PHD
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Telephone | 701-842-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHAR124
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License Number State | ND
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