Provider Demographics
NPI:1710024690
Name:IRSFELD PHARMACY PC
Entity Type:Organization
Organization Name:IRSFELD PHARMACY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRSFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-483-4858
Mailing Address - Street 1:33 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3950
Mailing Address - Country:US
Mailing Address - Phone:701-483-4858
Mailing Address - Fax:701-483-4926
Practice Address - Street 1:33 9TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3950
Practice Address - Country:US
Practice Address - Phone:701-483-4858
Practice Address - Fax:701-483-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20789Medicaid
ND0185890001Medicare ID - Type Unspecified