Provider Demographics
NPI:1740249929
Name:LAMOURE DRUG STORE, INC.
Entity type:Organization
Organization Name:LAMOURE DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAUF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-883-5339
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-0175
Mailing Address - Country:US
Mailing Address - Phone:701-883-5339
Mailing Address - Fax:701-883-5531
Practice Address - Street 1:100 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458-7415
Practice Address - Country:US
Practice Address - Phone:701-883-5339
Practice Address - Fax:701-883-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPHAR150332B00000X, 333600000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21260LAMedicaid
ND3501132OtherNCPDP NUMBER
AL7304645OtherDEA NUMBER
ND3501132OtherNCPDP NUMBER