Organization
CORNER DRUG STORE OF WAHPETON INC
Active
Other names
Corner Drug Store LTC
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS GLARUM PHARM.D (PHARMACIST IN CHARGE)
(701) 642-6223
Entity
Organization
Contact information
Practice address
619 DAKOTA AVE, WAHPETON, ND 58075-4325
(701) 642-6223
(701) 642-8839
Mailing address
619 DAKOTA AVE, WAHPETON, ND 58075-4325
(701) 642-6223
(701) 642-8839
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20159
—
ND
01
—
3501803
NCPDP
—
05
—
701260X
—
MN
Enumeration date
05/08/2019
Last updated
05/07/2024
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