Provider Demographics
NPI:1982655049
Name:CASSELTON DRUG INC
Entity Type:Organization
Organization Name:CASSELTON DRUG INC
Other - Org Name:ARTHUR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, RPH
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-347-4281
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:CASSELTON
Mailing Address - State:ND
Mailing Address - Zip Code:58012-0250
Mailing Address - Country:US
Mailing Address - Phone:701-734-4281
Mailing Address - Fax:701-347-5275
Practice Address - Street 1:340 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARTHUR
Practice Address - State:ND
Practice Address - Zip Code:58006-4002
Practice Address - Country:US
Practice Address - Phone:701-967-8900
Practice Address - Fax:701-967-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
ND5533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2071604OtherPK
2071604OtherPK