# NORTH DAKOTA STATE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NORTH DAKOTA STATE HOSPITAL PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043260722
- **Authorized official:** ROSALIE ETHERINGTON PHD (SUPERINTENDENT)
- **Authorized official phone:** (701) 253-3964

## Contact information

- **Practice address:** 1712 ELMWOOD PLACE, JAMESTOWN, ND 58401
- **Practice address phone:** (701) 269-2979
- **Practice address fax:** (701) 253-3035
- **Mailing address:** 1712 ELMWOOD PLACE, JAMESTOWN, ND 58401
- **Mailing address phone:** (701) 253-3650
- **Mailing address fax:** (701) 253-3035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | 188 | ND | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 02/08/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2071611 | PK | — |
| 05 | — | 21476 | — | ND |