Provider Demographics
NPI:1982826756
Name:INTEGRATED HEALTH MARKETING LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH MARKETING LLC
Other - Org Name:SEIP PRESCRIPTION SHOPPE #12
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-640-2722
Mailing Address - Street 1:5675 26TH AVE S STE 136A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8975
Mailing Address - Country:US
Mailing Address - Phone:701-373-0685
Mailing Address - Fax:701-373-0686
Practice Address - Street 1:5675 26TH AVE S STE 136A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8975
Practice Address - Country:US
Practice Address - Phone:701-373-0685
Practice Address - Fax:701-373-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPHAR7623336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140775OtherPK