# CORNER DRUG STORE OF WAHPETON INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Corner Drug Store LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821653577
- **Authorized official:** LUCAS GLARUM PHARM.D (PHARMACIST IN CHARGE)
- **Authorized official phone:** (701) 642-6223

## Contact information

- **Practice address:** 619 DAKOTA AVE, WAHPETON, ND 58075-4325
- **Practice address phone:** (701) 642-6223
- **Practice address fax:** (701) 642-8839
- **Mailing address:** 619 DAKOTA AVE, WAHPETON, ND 58075-4325
- **Mailing address phone:** (701) 642-6223
- **Mailing address fax:** (701) 642-8839

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/08/2019
- **Last updated:** 05/07/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 20159 | — | ND |
| 01 | — | 3501803 | NCPDP | — |
| 05 | — | 701260X | — | MN |