Provider Demographics
NPI:1710024807
Name:HAZEN DRUG INC.
Entity Type:Organization
Organization Name:HAZEN DRUG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-748-2312
Mailing Address - Street 1:30 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545
Mailing Address - Country:US
Mailing Address - Phone:701-748-2312
Mailing Address - Fax:701-748-2637
Practice Address - Street 1:30 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545
Practice Address - Country:US
Practice Address - Phone:701-748-2312
Practice Address - Fax:701-748-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20079Medicaid
ND20079Medicaid