Provider Demographics
NPI:1578588307
Name:WISHEK DRUG
Entity Type:Organization
Organization Name:WISHEK DRUG
Other - Org Name:WISHEK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AIPPERSPACH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-452-2368
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-0217
Mailing Address - Country:US
Mailing Address - Phone:701-454-2236
Mailing Address - Fax:701-452-2399
Practice Address - Street 1:9 S CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-7216
Practice Address - Country:US
Practice Address - Phone:701-452-2368
Practice Address - Fax:701-452-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
ND4933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2071267OtherPK
ND21343Medicaid
2071267OtherPK