Provider Demographics
NPI:1790941342
Name:BELCOURT DRUG INC
Entity Type:Organization
Organization Name:BELCOURT DRUG INC
Other - Org Name:BELCOURT DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-0202
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0080
Mailing Address - Country:US
Mailing Address - Phone:701-477-0202
Mailing Address - Fax:701-477-0205
Practice Address - Street 1:9775 BIA ROAD 9
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-0202
Practice Address - Fax:701-477-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NDPHAR5443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116403OtherPK
ND1455600Medicaid