Provider Demographics
NPI:1568541233
Name:DAKOTA PRECISION RX
Entity Type:Organization
Organization Name:DAKOTA PRECISION RX
Other - Org Name:DAKOTA PRECISION RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-255-1881
Mailing Address - Street 1:705 E MAIN AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4525
Mailing Address - Country:US
Mailing Address - Phone:701-255-1881
Mailing Address - Fax:701-255-7226
Practice Address - Street 1:705 E MAIN AVE
Practice Address - Street 2:STE 200
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4525
Practice Address - Country:US
Practice Address - Phone:701-255-1881
Practice Address - Fax:701-255-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPHAR4283336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21433Medicaid
2071516OtherPK
ND21433Medicaid