Provider Demographics
NPI:1205036027
Name:UNIVERSITY OF NORTH DAKOTA
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH DAKOTA
Other - Org Name:CENTER FOR FAMILY MEDICINE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-858-6755
Mailing Address - Street 1:1201 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4207
Mailing Address - Country:US
Mailing Address - Phone:701-858-6700
Mailing Address - Fax:701-858-6749
Practice Address - Street 1:1201 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4207
Practice Address - Country:US
Practice Address - Phone:701-858-6700
Practice Address - Fax:701-858-6749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1459416Medicaid