Provider Demographics
NPI:1255486908
Name:ECONOMY DRUG MOTT INC
Entity type:Organization
Organization Name:ECONOMY DRUG MOTT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:OIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-824-2897
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:216 BROWN AVE
Mailing Address - City:MOTT
Mailing Address - State:ND
Mailing Address - Zip Code:58646
Mailing Address - Country:US
Mailing Address - Phone:701-824-2897
Mailing Address - Fax:701-824-4321
Practice Address - Street 1:216 BROWN AVE
Practice Address - Street 2:
Practice Address - City:MOTT
Practice Address - State:ND
Practice Address - Zip Code:58646-7100
Practice Address - Country:US
Practice Address - Phone:701-824-8297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
ND5523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2070905OtherPK
ND020116Medicaid
ND020116Medicaid