Organization
SOUTHTOWN ECONODRUG, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA L. MCDONALD R.PH (PRESIDENT)
(701) 642-2336
Entity
Organization
Contact information
Practice address
387 11TH ST S, WAHPETON, ND 58075-4653
(701) 642-2336
(701) 642-1470
Mailing address
387 11TH ST S, WAHPETON, ND 58075-4653
(701) 642-2336
(701) 642-1470
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
152
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0776850001
MEDICARE PART B NSC#
ND
05
—
091062700
—
MN
05
—
21128
—
ND
05
—
9167120
—
SD
Enumeration date
10/28/2005
Last updated
11/06/2012
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