Organization
INTERSTATE RETAIL INC
Active
Organization
INTERSTATE RETAIL INC
Active
Other names
SERVICE DRUG PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN BOLINSKE RPH (OWNER)
(701) 572-6721
Entity
Organization
Contact information
Practice address
317 MAIN ST, WILLISTON, ND 58801-5303
(701) 572-6721
(701) 572-6723
Mailing address
317 MAIN ST, WILLISTON, ND 58801-5303
(701) 572-6721
(701) 572-6723
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
61
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020175
—
ND
01
—
3501928
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/25/2006
Last updated
04/20/2012
Update your record
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