Provider Demographics
NPI:1508924622
Name:LUTHERAN CHARITY ASSOCIATION
Entity Type:Organization
Organization Name:LUTHERAN CHARITY ASSOCIATION
Other - Org Name:JAMESTOWN HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-952-4850
Mailing Address - Street 1:2422 20TH ST SW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-6201
Mailing Address - Country:US
Mailing Address - Phone:701-952-4820
Mailing Address - Fax:701-952-3263
Practice Address - Street 1:2422 20TH ST SW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-6201
Practice Address - Country:US
Practice Address - Phone:701-952-4820
Practice Address - Fax:701-952-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ND1733336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1452359Medicaid
2070841OtherPK