Organization
CORNER DRUG STORE OF WAHPETON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS BRADLEY GLARUM PHARM.D (PHARMACIST IN CHARGE)
(701) 642-6223
Entity
Organization
Contact information
Practice address
619 DAKOTA AVE, WAHPETON, ND 58075-4325
(701) 642-6223
(701) 642-8839
Mailing address
619 DAKOTA AVE, WAHPETON, ND 58075-4325
(701) 642-6223
(701) 642-8839
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
15
ND
3336L0003X
Long Term Care Pharmacy
PHAR15
ND
3336S0011X
Specialty Pharmacy
PHAR15
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20159
—
ND
01
—
3501803
NABP
—
05
—
701260X
—
MN
Enumeration date
04/17/2007
Last updated
03/13/2024
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