NPIMap

Organization Active NPI

Pamida Stores Operating Co LLC

Doing business as Pamida Pharmacy 13

  • Community/Retail Pharmacy
  • Wadena, MN
National Provider Identifier
1164476396
Registry record updated Nov 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
262786-3 Issued in MN
Legal business name
PAMIDA STORES OPERATING CO LLC
Doing business as
Pamida Pharmacy 13
Practice address
801 Jefferson St N
Wadena, MN 56482-2334
Phone
(218) 631-1546
Fax
(218) 631-1548
NPI assigned
May 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John Harlow
Title
Ceo/President
Phone
(402) 596-7206

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 262786-3 MN Primary

Addresses

Primary practice location

801 Jefferson St N
Wadena, MN 56482-2334

Mailing address

801 Jefferson St N.
Wadena, MN 56482-2334
Phone (218) 631-1546

Other identifiers 3

IdentifierTypeStateIssuer
769418100MedicaidMN
005450100MedicaidMN
2425040OtherNCPDP

Other names 1

  • Pamida Pharmacy 13 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pamida Stores Oper Comp LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

801 Jefferson St N
Wadena, MN 56482
Phone (218) 631-1546

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1164476396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 JEFFERSON ST N.",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564822334",
            "telephone_number": "218-631-1546",
            "fax_number": "218-631-1548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 JEFFERSON ST N",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564822334",
            "telephone_number": "218-631-1546",
            "fax_number": "218-631-1548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAMIDA STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "HARLOW",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "402-596-7206",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262786-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "769418100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005450100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2425040",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pamida Pharmacy 13",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wadena, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.