Organization
YE OLDE MEDICINE SHOPPE INC
Active
Other names
Drayton Drug
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE LARSON R.PH. (PRESIDENT)
(701) 284-7676
Entity
Organization
Contact information
Practice address
104 E HIGHWAY 66, DRAYTON, ND 58225-4804
(701) 454-3831
(701) 454-3338
Mailing address
104 E HIGHWAY 66, DRAYTON, ND 58225-4804
(701) 454-3831
(701) 454-3338
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR362
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125584
PK
—
05
—
21549
—
ND
Enumeration date
05/25/2010
Last updated
10/26/2016
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