Provider Demographics
NPI:1740380542
Name:HILLSBORO DRUG & GIFT, INC.
Entity Type:Organization
Organization Name:HILLSBORO DRUG & GIFT, INC.
Other - Org Name:HILLSBORO DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HABECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:701-636-5231
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-0820
Mailing Address - Country:US
Mailing Address - Phone:701-636-5231
Mailing Address - Fax:701-636-5947
Practice Address - Street 1:13 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045
Practice Address - Country:US
Practice Address - Phone:701-636-5231
Practice Address - Fax:701-636-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ND63333600000X
NDPHAR633336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20083Medicaid
MN790858000Medicaid
MN790858000Medicaid