Provider Demographics
NPI:1184669616
Name:S & V INC
Entity Type:Organization
Organization Name:S & V INC
Other - Org Name:COUNTRY DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES CHIEF PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STUDSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-974-3558
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:
Mailing Address - City:RICHARDTON
Mailing Address - State:ND
Mailing Address - Zip Code:58652-0910
Mailing Address - Country:US
Mailing Address - Phone:701-974-3558
Mailing Address - Fax:701-974-3555
Practice Address - Street 1:116 N AVE E
Practice Address - Street 2:
Practice Address - City:RICHARDTON
Practice Address - State:ND
Practice Address - Zip Code:58652-0910
Practice Address - Country:US
Practice Address - Phone:701-974-3558
Practice Address - Fax:701-974-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND130333600000X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3501601OtherOTHER ID NUMBER-COMMERCIAL NUMBER
ND21071Medicaid
3501601OtherOTHER ID NUMBER-COMMERCIAL NUMBER