Provider Demographics
NPI:1003906942
Name:WHITE DRUG CO OF JAMESTOWN INC
Entity Type:Organization
Organization Name:WHITE DRUG CO OF JAMESTOWN INC
Other - Org Name:WHITE DRUG #61
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROISTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-513-4377
Mailing Address - Street 1:6055 NATHAN LN N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:763-513-4300
Mailing Address - Fax:763-513-4380
Practice Address - Street 1:706 38TH ST N
Practice Address - Street 2:UNIT A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2953
Practice Address - Country:US
Practice Address - Phone:701-893-9050
Practice Address - Fax:701-893-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK14093336L0003X
DEA9-00014643336L0003X
GAPHNR0010113336L0003X
DCNRX00005213336L0003X
CTPCN.00027143336L0003X
KS22-445333336L0003X
FL272633336L0003X
IL054.0186873336L0003X
HIPMP-9873336L0003X
COOSP.00064403336L0003X
CANRP14633336L0003X
KYND18393336L0003X
IA37223336L0003X
IN64001649A3336L0003X
ID35705MS3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN924692000Medicaid
ND1460158 DMEMedicaid
ND1455652 RXMedicaid
2071512OtherPK
N711311Medicare PIN