Provider Demographics
NPI:1558376152
Name:ND PHARMACY INC
Entity Type:Organization
Organization Name:ND PHARMACY INC
Other - Org Name:N D PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TREITLINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-225-4434
Mailing Address - Street 1:20 26TH ST E
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3046
Mailing Address - Country:US
Mailing Address - Phone:701-572-4181
Mailing Address - Fax:701-572-0921
Practice Address - Street 1:20 26TH ST E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3046
Practice Address - Country:US
Practice Address - Phone:701-572-4181
Practice Address - Fax:701-572-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ND393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3502843OtherNCPDP PROVIDER IDENTIFICATION NUMBER
ND20811Medicaid
0339010003Medicare NSC