Provider Demographics
NPI:1477212116
Name:MS4 PLLC
Entity Type:Organization
Organization Name:MS4 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-293-0221
Mailing Address - Street 1:8001 JACKS WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-2802
Mailing Address - Country:US
Mailing Address - Phone:701-997-5337
Mailing Address - Fax:701-997-5338
Practice Address - Street 1:8001 JACKS WAY STE 101
Practice Address - Street 2:
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047-2802
Practice Address - Country:US
Practice Address - Phone:701-997-5337
Practice Address - Fax:701-997-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy