MEDICARE: WHITE DRUG CO OF JAMESTOWN 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
3	3336L0003X	Long Term Care Pharmacy
4	291U00000X	Clinical Medical Laboratory
5	3336C0003X	Community/Retail Pharmacy	PHAR374	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2071484	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396834909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE DRUG CO OF JAMESTOWN INC

Provider Business Mailing Address
First Line	:	6701 EVENSTAD DR N STE 100
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-6013
Country	:	US
Telephone Number	:	763-513-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 5TH ST NE
Second Line	:
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-2476
Country	:	US
Telephone Number	:	701-662-3022
Fax Number	:	701-662-2042

Authorized Official
Title or Position	:	LICENSING COORDINATOR
Name	:	ANNE FROISTAD
Credential	:
Telephone Number	:	763-513-4377

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/29/2024

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Directions to “WHITE DRUG CO OF JAMESTOWN INC ” Practice Location

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