Provider Demographics
NPI:1114678737
Name:WHITE DRUG CO OF JAMESTOWN INC
Entity type:Organization
Organization Name:WHITE DRUG CO OF JAMESTOWN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROISTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-513-4377
Mailing Address - Street 1:6701 EVENSTAD DR N STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6013
Mailing Address - Country:US
Mailing Address - Phone:763-513-4300
Mailing Address - Fax:
Practice Address - Street 1:1532 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5987
Practice Address - Country:US
Practice Address - Phone:701-478-8155
Practice Address - Fax:701-997-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDPHAR424OtherBOARD OF PHARMACY