MEDICARE: NEW SALEM PHARMACY LLC

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	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHAR768	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2137202	OTHER		PK

General Provider Information

NPI Number	:	1710056452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SALEM PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX H
Second Line	:
City	:	NEW SALEM
State	:	ND
Zip	:	58563-0426
Country	:	US
Telephone Number	:	701-843-7563
Fax Number	:	701-843-7564

Provider Business Practice Location Address
First Line	:	509 ASH AVE
Second Line	:
City	:	NEW SALEM
State	:	ND
Zip	:	58563-4501
Country	:	US
Telephone Number	:	701-843-7563
Fax Number	:	701-843-7564

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL CHURCHILL
Credential	:	PHARMD
Telephone Number	:	701-224-0339

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	09/02/2022

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Directions to “NEW SALEM PHARMACY LLC ” Practice Location

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