Provider Demographics
NPI:1245347368
Name:TELEPHARMACY CONCEPTS INC.
Entity type:Organization
Organization Name:TELEPHARMACY CONCEPTS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-872-2800
Mailing Address - Street 1:180 S CENTRAL AVE
Mailing Address - Street 2:PO BOX 880
Mailing Address - City:BEACH
Mailing Address - State:ND
Mailing Address - Zip Code:58621-4001
Mailing Address - Country:US
Mailing Address - Phone:701-872-2800
Mailing Address - Fax:701-872-2801
Practice Address - Street 1:180 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BEACH
Practice Address - State:ND
Practice Address - Zip Code:58621-4001
Practice Address - Country:US
Practice Address - Phone:701-872-2800
Practice Address - Fax:701-872-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21381Medicaid
ND4578910001Medicare NSC