YE OLDE MEDICINE SHOPPE (NPI# 1720020324) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720020324 |
| Entity Type | Organization |
| Organization Name | YE OLDE MEDICINE SHOPPE |
| Other Organization Name | YE OLDE MEDICINE CENTER |
| Practice Address |
503 Park St W Park River ND 58270-4137 |
| Practice Telephone | 7012847676 |
| Practice Fax Number | 7012846129 |
| Mailing Telephone | 7012847676 |
| Mailing Fax Number | 7012846129 |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2018-07-19 |
| Authorized Official Name | LAURIE LARSON (PRESDIENT) |
| Authorized Official Telephone | 7012847676 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHAR59 | ND | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 20668 | 05 | |
| PK | 2071194 | 01 |
| Other Name | Type Code |
|---|---|
| YE OLDE MEDICINE CENTER | Doing Business As Name - Organization |
| Street Address |
503 PARK ST W |
| City | PARK RIVER |
| State | ND |
| Zip Code | 58270-4137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558971168 | Taylor Marie Kelsey | Pharmacist | 503 Park St W, Park River, ND 58270-4137 | 2020-08-07 |
| 1003469347 | Piper Luoto | Pharmacist | 503 Park St W, Park River, ND 58270-4137 | 2019-07-16 |
| 1801315874 | Daniel James Degree | Pharmacist | 503 Park St W, Park River, ND 58270-4137 | 2017-09-11 |
| 1538501226 | Kristin Marie Stabo | Nurse Practitioner | 503 Park St W, Park River, ND 58270-4137 | 2013-07-23 |
| 1275842312 | Kara Ruhland | Pharmacist | 503 Park St W, Park River, ND 58270-4137 | 2010-10-06 |
| 1619119591 | Midgarden Family Clinic PC | Clinic/Center | 503 Park St W, Park River, ND 58270-4103 | 2009-03-24 |
| 1841374030 | Kristi J Midgarden | Family Medicine | 503 Park St W, Park River, ND 58270-4103 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740769595 | The Evangelical Lutheran Good Samaritan Society | Nurse Practitioner | 301 S Highway 12b, Park River, ND 58270 | 2018-08-13 |
| 1104317189 | Paul Benedict Dusek | Dentist | 321 Briggs Ave S Ste 3, Park River, ND 58270 | 2018-05-24 |
| 1669880845 | Lifetime Dental, PC | Clinic/Center | 321 Briggs Ave S, Suite 3, Park River, ND 58270 | 2014-07-31 |
| 1063850436 | Achieve Therapy LLC | Physical Therapist | 102 4th St W, Park River, ND 58270 | 2013-06-07 |
| 1740473800 | Riverview Healthcare Association | Clinic/Center | 115 Vivian St, Park River, ND 58270 | 2007-08-22 |
| 1285847269 | Brian James Larson | Dentist | 418 Briggs Ave S, Park River, ND 58270 | 2007-05-07 |
| 1033137070 | Roberta L Ekman | Dentist | 321 Briggs Ave, Park River, ND 58270 | 2006-07-17 |
| 1679128664 | Lyndsi E Klundt | Physical Therapist | 102 4th St W, Park River, ND 58270 | 2019-08-06 |
| 1508426735 | Allie Beneda | Physical Therapy Assistant | 115 Vivian St., Park River, ND 58270 | 2019-06-19 |
| 1770795767 | Laurelyn Joann Larson | Pharmacist | Highway 17, Park River, ND 58270 | 2007-05-04 |
| Find all providers in zip 58270 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| 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 |
|---|---|---|---|---|
| 1053879734 | Mpnd,inc | Pharmacy | 2050 Sheyenne Street, West Fargo, ND 58078 | 2019-03-12 |
| 1912416876 | Lifescript Pharmacy Pllc | Pharmacy | 5670 38th Ave S Unit A, Fargo, ND 58104-9051 | 2017-09-23 |
| 1205231990 | N D Pharmacy Inc | Pharmacy | 1283 Roughrider Blvd, Dickinson, ND 58601-6780 | 2014-10-24 |
| 1063839496 | G & G Rx Inc | Pharmacy | 1500 14th Street West, Suite 150, Williston, ND 58801-5303 | 2014-03-24 |
| 1962706036 | Inhealth Specialty Pharmacy, Inc. | Pharmacy | 2345 25th St S Ste C, Fargo, ND 58103-6173 | 2011-01-05 |
| 1982826756 | Integrated Health Marketing LLC | Pharmacy | 5675 26th Ave S Ste 136a, Fargo, ND 58104-8975 | 2007-05-02 |
| 1689725434 | Tioga Drug Inc | Pharmacy | 106 N. Main St., Tioga, ND 58852 | 2007-01-16 |
| 1891855326 | Sanger Inc | Pharmacy | 4101 13th Ave S, Fargo, ND 58103-3342 | 2006-12-12 |
| 1457419962 | Johnson Drug Co | Pharmacy | 2522 N Broadway, Fargo, ND 58102 | 2006-12-05 |
| 1306931977 | B & E Pharmacy Services Inc | Pharmacy | 2015 Library Circle, Grand Forks, ND 58201 | 2006-10-03 |
| Find all providers with the same taxonomy | ||||
| City | PARK RIVER |
| Zip Code | 58270 |
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| 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.