Provider Demographics
NPI:1124064043
Name:GRAFTON DRUG COMPANY
Entity type:Organization
Organization Name:GRAFTON DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHOTT LAPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-352-0217
Mailing Address - Street 1:501 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 HILL AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1443
Practice Address - Country:US
Practice Address - Phone:701-352-0831
Practice Address - Fax:701-352-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND34333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20064Medicaid
3500875OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3500875OtherOTHER ID NUMBER-COMMERCIAL NUMBER