Organization
THOMAS MOE
Active
Other names
NORTHBROOK DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
TOM MOE RPH (OWNER)
(701) 258-1412
Entity
Organization
Contact information
Practice address
1929 N WASHINGTON ST, STE C, BISMARCK, ND 58501-1616
(701) 258-1412
(701) 258-1413
Mailing address
1929 N WASHINGTON ST, STE C, BISMARCK, ND 58501-1616
(701) 258-1412
(701) 258-1413
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20617
—
ND
01
—
3502033
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/10/2006
Last updated
08/01/2011
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