Provider Demographics
NPI:1801328133
Name:EMBRACE PHARMACY INC
Entity type:Organization
Organization Name:EMBRACE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-757-1552
Mailing Address - Street 1:2424 32ND AVE S
Mailing Address - Street 2:STE 101B
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6508
Mailing Address - Country:US
Mailing Address - Phone:701-757-1552
Mailing Address - Fax:701-757-1542
Practice Address - Street 1:2424 32ND AVE S STE 101B
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6509
Practice Address - Country:US
Practice Address - Phone:701-757-1552
Practice Address - Fax:701-757-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NDPHAR2423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168668OtherPK