Provider Demographics
NPI:1417968074
Name:PHARMACISTS ASSOCIATES LLC
Entity Type:Organization
Organization Name:PHARMACISTS ASSOCIATES LLC
Other - Org Name:LAKOTA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-652-2651
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:LAKOTA
Mailing Address - State:ND
Mailing Address - Zip Code:58344-0309
Mailing Address - Country:US
Mailing Address - Phone:701-247-2781
Mailing Address - Fax:701-247-2643
Practice Address - Street 1:117 MAIN ST N
Practice Address - Street 2:
Practice Address - City:LAKOTA
Practice Address - State:ND
Practice Address - Zip Code:58344-7105
Practice Address - Country:US
Practice Address - Phone:701-247-2781
Practice Address - Fax:701-247-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND867333600000X
NDPHAR8673336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21613Medicaid
ND7351590001Medicare NSC