NORTH DAKOTA STATE UNIVERSITY (NPI# 1972000768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972000768 |
| Entity Type | Organization |
| Organization Name | NORTH DAKOTA STATE UNIVERSITY |
| Other Organization Name | FAMILY HEALTHCARE PHARMACY SOUTH |
| Practice Address |
4025 9th Ave S Fargo ND 58103-2101 |
| Mailing Address |
301 Np Avenue Fargo ND 58102-4835 |
| Practice Telephone | 7012716390 |
| Practice Fax Number | 7012713345 |
| Mailing Telephone | 7012716390 |
| Mailing Fax Number | 7012713345 |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2018-04-09 |
| Authorized Official Name | SUSAN WOLF NELSON (PHARMACY DIRECTOR) |
| Authorized Official Telephone | 7012716390 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | Y |
| Parent Organization Name | NORTH DAKOTA STATE UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
PHAR252 | ND | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | STATE PHARMACY LICENSE | PHAR252 | 01 |
| Other Name | Type Code |
|---|---|
| Family HealthCare Pharmacy South | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194805796 | North Dakota State University | Pharmacy | 301 Np Avenue, Fargo, ND 58102 | 2006-10-17 |
| 1427152115 | North Dakota State University | Pharmacist | 1707 Centennial Boulevard, Fargo, ND 58102 | 2006-09-12 |
| 1811939416 | North Dakota State University | Pharmacy | 1707 Centennial Blvd, Fargo, ND 58102 | 2006-06-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | NORTH DAKOTA STATE UNIVERSITY | 1919 University Dr N, Ste 102, Fargo, ND 58102-1843 |
| Street Address |
4025 9TH AVE S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-2101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841701877 | Family Health Care Center | Clinic/Center | 4025 9th Ave S, Fargo, ND 58103-2101 | 2017-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| 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 |
| 1639254113 | Prescription Center Pharmacy Inc. | Pharmacy | 2701 13th Ave S, Fargo, ND 58103-3602 | 2006-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
Please comment or provide details below to improve the information on NORTH DAKOTA STATE UNIVERSITY.
| 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.