Provider Demographics
NPI:1982734042
Name:UNIVERSITY OF NORTH DAKOTA
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH DAKOTA
Other - Org Name:CENTER FOR FAMILY MEDICINE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:701-858-6755
Mailing Address - Street 1:1201 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4207
Mailing Address - Country:US
Mailing Address - Phone:701-858-6755
Mailing Address - Fax:
Practice Address - Street 1:1201 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4207
Practice Address - Country:US
Practice Address - Phone:701-858-6755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3631835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0695060004Medicare NSC