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Contact Information

CORNER DRUG STORE OF WAHPETON INC
619 DAKOTA AVE
WAHPETON, ND58075-4325
 Phone: 701-642-6223
 Fax: 701-642-8839
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Specialty Pharmacy

3336S0011X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for CORNER DRUG STORE OF WAHPETON INC

NPI Number 1134345457
LBN Legal business name CORNER DRUG STORE OF WAHPETON INC
Authorized official LUCAS GLARUM - (PHARMACIST IN CHARGE)
Entity Organization
Organization subpart 1 No
Enumeration date 04/17/2007
Last updated 03/13/2024 - About 2 years ago
Identifiers
ND License # 15
ND License # PHAR15
MN Medicaid 701260X
ND Medicaid 20159
Other 3501803 NABP
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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