Provider Demographics
NPI:1689725434
Name:TIOGA DRUG INC
Entity Type:Organization
Organization Name:TIOGA DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-664-2116
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:ND
Mailing Address - Zip Code:58852-0639
Mailing Address - Country:US
Mailing Address - Phone:701-664-2116
Mailing Address - Fax:701-664-2463
Practice Address - Street 1:106 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TIOGA
Practice Address - State:ND
Practice Address - Zip Code:58852
Practice Address - Country:US
Practice Address - Phone:701-664-2116
Practice Address - Fax:701-664-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20152Medicaid
ND20152Medicaid