Organization
CORNER DRUG STORE OF WAHPETON INC
Active
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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