Provider Demographics
NPI:1679663512
Name:WHITE DRUG CO OF JAMESTOWN INC
Entity Type:Organization
Organization Name:WHITE DRUG CO OF JAMESTOWN INC
Other - Org Name:WHITE DRUG #40
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROISTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-513-4377
Mailing Address - Street 1:6055 NATHAN LN N STE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1675
Mailing Address - Country:US
Mailing Address - Phone:763-513-4300
Mailing Address - Fax:763-513-4380
Practice Address - Street 1:2211 16TH ST NW STE B
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1215
Practice Address - Country:US
Practice Address - Phone:701-852-0388
Practice Address - Fax:701-852-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
NDPHAR783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455515 RXMedicaid
ND1458184 DMEMedicaid
2071259OtherPK
N711311Medicare PIN