MEDICARE: CHASE DRUG STORE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	160	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70482	OTHER		BCBS OF ND
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265548101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHASE DRUG STORE INC

Provider Business Mailing Address
First Line	:	703 MAIN AVE
Second Line	:	PO BOX 400
City	:	WASHBURN
State	:	ND
Zip	:	58577
Country	:	US
Telephone Number	:	701-462-8174
Fax Number	:	701-462-3597

Provider Business Practice Location Address
First Line	:	703 MAIN AVENUE
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-0400
Country	:	US
Telephone Number	:	701-462-8174
Fax Number	:	701-462-3597

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. MIKE CHASE
Credential	:
Telephone Number	:	701-462-8174

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	05/15/2008

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Directions to “CHASE DRUG STORE INC ” Practice Location

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