Provider Demographics
NPI:1235813502
Name:S.A. WARREN,LLC
Entity Type:Organization
Organization Name:S.A. WARREN,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JODEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-720-3182
Mailing Address - Street 1:1118 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-5955
Mailing Address - Country:US
Mailing Address - Phone:701-441-7345
Mailing Address - Fax:866-291-1415
Practice Address - Street 1:1118 S BROADWAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5955
Practice Address - Country:US
Practice Address - Phone:701-441-7345
Practice Address - Fax:866-291-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy