Provider Demographics
NPI:1508182684
Name:P R HEALTH CORPORATION
Entity Type:Organization
Organization Name:P R HEALTH CORPORATION
Other - Org Name:FIRST CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRYBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-284-7500
Mailing Address - Street 1:115 VIVIAN ST W
Mailing Address - Street 2:P O BOX I
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-4540
Mailing Address - Country:US
Mailing Address - Phone:701-284-7500
Mailing Address - Fax:701-284-6747
Practice Address - Street 1:115 VIVIAN ST W
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-4540
Practice Address - Country:US
Practice Address - Phone:701-284-7500
Practice Address - Fax:701-284-6747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P R HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-14
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5042P332900000X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20838Medicaid