| NPI | 1134345457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCAS BRADLEY GLARUM Pharmacist In Charge 701-642-6223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: ND 15) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: ND Phar15) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: ND Phar15) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-03-13 |