Provider Demographics
NPI:1205231990
Name:N D PHARMACY INC
Entity Type:Organization
Organization Name:N D PHARMACY INC
Other - Org Name:ND PHARMACY WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TREITLINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-225-4434
Mailing Address - Street 1:446 18TH ST W
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3022
Mailing Address - Country:US
Mailing Address - Phone:701-483-0724
Mailing Address - Fax:701-483-1882
Practice Address - Street 1:1283 ROUGHRIDER BLVD
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6780
Practice Address - Country:US
Practice Address - Phone:701-483-0724
Practice Address - Fax:701-483-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPHAR3233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000020084Medicaid
2148589OtherPK