Provider Demographics
NPI:1063690774
Name:PHARMACISTS ASSOCIATES LLC
Entity type:Organization
Organization Name:PHARMACISTS ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-256-3330
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0399
Mailing Address - Country:US
Mailing Address - Phone:701-587-5271
Mailing Address - Fax:701-587-6091
Practice Address - Street 1:10 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-0399
Practice Address - Country:US
Practice Address - Phone:701-587-5271
Practice Address - Fax:701-587-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20136Medicaid
0742440001Medicare UPIN
ND0742440001Medicare NSC