Provider Demographics
NPI:1235264862
Name:MARKET PHARMACY INC
Entity Type:Organization
Organization Name:MARKET PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-839-8883
Mailing Address - Street 1:1930 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6508
Mailing Address - Country:US
Mailing Address - Phone:701-839-8883
Mailing Address - Fax:701-837-1555
Practice Address - Street 1:1930 S BROADWAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6508
Practice Address - Country:US
Practice Address - Phone:701-839-8883
Practice Address - Fax:701-837-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21095Medicaid
ND21095Medicaid