Provider Demographics
NPI:1770698714
Name:DAKOTA DRUG COMPANY OF STANLEY
Entity type:Organization
Organization Name:DAKOTA DRUG COMPANY OF STANLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH,VP
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:701-628-2255
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-4003
Mailing Address - Country:US
Mailing Address - Phone:701-628-2255
Mailing Address - Fax:701-628-2396
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4003
Practice Address - Country:US
Practice Address - Phone:701-628-2255
Practice Address - Fax:701-628-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 333600000X
NDPHAR273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122398OtherPK
ND1458601Medicaid
0397260001Medicare NSC