Provider Demographics
NPI:1285651984
Name:PHARMACISTS ASSOCIATES LLC
Entity type:Organization
Organization Name:PHARMACISTS ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-256-3330
Mailing Address - Street 1:314 OHMER ST
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1045
Mailing Address - Country:US
Mailing Address - Phone:701-228-2220
Mailing Address - Fax:701-228-5827
Practice Address - Street 1:314 OHMER ST
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1045
Practice Address - Country:US
Practice Address - Phone:701-228-2220
Practice Address - Fax:701-228-5827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACISTS ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6533336C0003X
NDPHAR6533336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21600Medicaid
ND3500318OtherNABP/NCPDP
ND3500318OtherNABP/NCPDP
NDFP3637014OtherDEA