Provider Demographics
NPI:1740228774
Name:KB PHARMACY PLLC
Entity Type:Organization
Organization Name:KB PHARMACY PLLC
Other - Org Name:GRAFTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOREK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-352-0831
Mailing Address - Street 1:38 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2212
Mailing Address - Country:US
Mailing Address - Phone:701-352-0831
Mailing Address - Fax:701-352-1910
Practice Address - Street 1:38 E 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2212
Practice Address - Country:US
Practice Address - Phone:701-352-0831
Practice Address - Fax:701-352-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPHAR730332B00000X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1454130Medicaid
2071615OtherPK
2071615OtherPK