Provider Demographics
NPI:1770639130
Name:ARROWHEAD PLAZA DRUG INC
Entity Type:Organization
Organization Name:ARROWHEAD PLAZA DRUG INC
Other - Org Name:ARROWHEAD PLAZA DRUG PLAZA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FURCHT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-223-8806
Mailing Address - Street 1:1116 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-223-8806
Mailing Address - Fax:701-224-9717
Practice Address - Street 1:1116 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-223-8806
Practice Address - Fax:701-224-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4468183500000X
ND329333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21517Medicaid
3503263OtherNCPDP