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NPI Code Detail

MEDICARE: BISMARCK PHARMACY LLC

MEDICARE: BISMARCK 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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1922618289
Entity Type Code : Organization
Provider Name (Legal Business Name) : BISMARCK PHARMACY LLC
Provider Business Mailing Address
First Line : 1325 57TH AVE NE
Second Line :
City : BISMARCK
State : ND
Zip : 58503-6581
Country : US
Telephone Number : 701-415-7013
Fax Number :
Provider Business Practice Location Address
First Line : 1325 57TH AVE NE
Second Line :
City : BISMARCK
State : ND
Zip : 58503-6581
Country : US
Telephone Number : 701-415-7013
Fax Number : 701-415-7014
Authorized Official
Title or Position : OWNER/ PRESIDENT
Name : RICARDO J REYES
Credential : PHARMD
Telephone Number : 701-415-7013
Provider Enumeration Date : 08/03/2020
Last Update Date : 08/03/2020

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Directions to “BISMARCK PHARMACY LLC ” Practice Location

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