Provider Demographics
NPI:1891808523
Name:NEUMANN REXALL DRUG
Entity Type:Organization
Organization Name:NEUMANN REXALL DRUG
Other - Org Name:NEUMANN DRUG
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:NARVESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-968-3531
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-0459
Mailing Address - Country:US
Mailing Address - Phone:701-968-3531
Mailing Address - Fax:701-968-3560
Practice Address - Street 1:412 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-0459
Practice Address - Country:US
Practice Address - Phone:701-968-3531
Practice Address - Fax:701-968-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21042Medicaid
ND21042Medicaid