Provider Demographics
NPI:1922618289
Name:BISMARCK PHARMACY LLC
Entity Type:Organization
Organization Name:BISMARCK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-415-7013
Mailing Address - Street 1:1325 57TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6581
Mailing Address - Country:US
Mailing Address - Phone:701-415-7013
Mailing Address - Fax:
Practice Address - Street 1:1325 57TH AVE NE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6581
Practice Address - Country:US
Practice Address - Phone:701-415-7013
Practice Address - Fax:701-415-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy