Provider Demographics
NPI:1629222542
Name:SELZLER PHARMACY INC
Entity Type:Organization
Organization Name:SELZLER PHARMACY INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SELZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-324-2295
Mailing Address - Street 1:722 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1520
Mailing Address - Country:US
Mailing Address - Phone:701-324-2295
Mailing Address - Fax:
Practice Address - Street 1:722 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1520
Practice Address - Country:US
Practice Address - Phone:701-324-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21519Medicaid
ND21519Medicaid
NDN714106Medicare PIN