Organization
ST. ALEXIUS COMMUNITY PHARMACY
Active
Parent organization
ST ALEXIUS MEDICAL CENTER
Other names
Community Pharmacy RT/DME
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST ALEXIUS MEDICAL CENTER
Authorized official
MR. RICKY L DETWILLER R.PH. (DIRECTOR, OUTPATIENT PHARMACY SERV)
(701) 530-6926
Entity
Organization
Contact information
Practice address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-6906
(701) 530-6907
Mailing address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-6906
(701) 530-6907
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
190
ND
333600000X
Pharmacy
Primary
190
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000021438
—
ND
Enumeration date
10/21/2008
Last updated
01/27/2009
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