WALLS ALTRU PHARMACY INC (NPI# 1376632067) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376632067 |
| Entity Type | Organization |
| Organization Name | WALLS ALTRU PHARMACY INC |
| Other Organization Name | WALLS HEALTH MART PHARMACY |
| Practice Address |
4440 S Washington St Ste 101d Grand Forks ND 58201-7245 |
| Practice Telephone | 7017322900 |
| Practice Fax Number | 7017322909 |
| Mailing Telephone | 7017322900 |
| Mailing Fax Number | 7017322909 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-10-01 |
| Authorized Official Name | DENNIS PAUL JOHNSON (OWNER PRESIDENT) |
| Authorized Official Telephone | 7017460497 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHAR815 | ND | Suppliers |
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
Suppliers | ||
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
264179 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 21479 | 05 | |
| PK | 2071617 | 01 | |
| MN | 734967100 | 05 |
| Other Name | Type Code |
|---|---|
| Walls Health Mart Pharmacy | Doing Business As Name - Organization |
| Street Address |
4440 S WASHINGTON ST STE 101D |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-7245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497846299 | Brenda K Hanson | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2006-09-27 |
| 1942832456 | Qin Du | Orthopaedic Surgery | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2020-02-12 |
| 1477036374 | Alexandra Webb | Audiologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-09-07 |
| 1538647722 | Rebecca Pulkrabek | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-31 |
| 1083100036 | Nicole Morgan | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-02 |
| 1760984892 | Todd Jensen | Specialist/Technologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-03-05 |
| 1093236267 | Agatha J Ottem Lill | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-06-28 |
| 1629519418 | Bennett Leitch | Specialist/Technologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-03-14 |
| 1699214387 | Altru Health System | Clinic/Center | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-02-15 |
| 1548654585 | Megan Nicole Kipp | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2015-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194805796 | North Dakota State University | Pharmacy | 301 Np Avenue, Fargo, ND 58102 | 2006-10-17 |
| 1811939416 | North Dakota State University | Pharmacy | 1707 Centennial Blvd, Fargo, ND 58102 | 2006-06-11 |
| 1972000768 | North Dakota State University | Pharmacy | 4025 9th Ave S, Fargo, ND 58103-2101 | 2018-04-09 |
| 1265884308 | Spirit Lake Tribe | Pharmacy | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-07-12 |
| 1730307125 | Trenton Indian Service Area | Pharmacy | 331 4th Ave E, Trenton, ND 58853-9998 | 2007-04-23 |
| 1639254113 | Prescription Center Pharmacy Inc. | Pharmacy | 2701 13th Ave S, Fargo, ND 58103-3602 | 2006-10-25 |
| City | GRAND FORKS |
| Zip Code | 58201 |
Please comment or provide details below to improve the information on WALLS ALTRU PHARMACY INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.