White Drug Co of Jamestown Inc
Organization Active NPI Community/Retail Pharmacy · Lisbon, ND
NPI 1184932063 · NPPES record last updated Jul 21, 2026
Key facts
- NPI
- 1184932063
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHAR966 (ND)
- Legal business name
- WHITE DRUG CO OF JAMESTOWN INC
- Practice address
- 404 Main St
Lisbon, ND 58054-4142 - Phone
- (701) 683-4691
- Fax
- (800) 279-9611
- NPI assigned
- Sep 14, 2010
- Organization subpart
- No
Authorized official
- Name
- Anne Brader
- Title
- Cfo
- Phone
- (763) 513-4300
Other NPIs on the same Medicare enrollment 29
Corporate family (same tax ID) 26
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| White Drug #072 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Surgical Dressings | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040116000097 | ND | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204737943 |
32 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Grand Forks, ND; Lisbon, ND; Hettinger, ND; Jamestown, ND; Linton, ND; Maddock, ND; Minot, ND; Mohall, ND… |
| O20110131000803 | ND | DME Supplier - Pharmacy | 6204737943 | Practice locations: Lisbon, ND |
National Provider Directory
- Tax ID family
- White Drug 40
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHAR966 | ND | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
404 Main St
Lisbon, ND 58054-4142
Mailing address
6701 Evenstad Dr N Ste 100
Maple Grove, MN 55369-6013
Phone (763) 513-4300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000021553 | Medicaid | ND | |
| 2126718 | Other | PK | |
| 1184932063 | Medicaid | MN |
Other names
- White Drug #72
Other providers in Lisbon, ND
- Jonathan Tyre
- Stacey Maria Walton
- Sierra Dawn Weight
- Patricia Well
- Roberto A Wharton
- Corey Clark Williams
All providers in Lisbon, ND · Community/Retail Pharmacy in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.