NPIMap

Organization Active NPI

North Dakota State University

Doing business as Family HealthCare Pharmacy, NDSU

  • Clinic Pharmacy
  • Fargo, ND
National Provider Identifier
1194805796
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
117 Issued in ND
Legal business name
NORTH DAKOTA STATE UNIVERSITY
Doing business as
Family HealthCare Pharmacy, NDSU
Practice address
301 NP Avenue
Fargo, ND 58102
Phone
(701) 271-1489
NPI assigned
Oct 17, 2006
Organization subpart
Yes
Parent organization
NORTH DAKOTA STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Jennifer Iverson, RPH
Title
Pharmacist in Charge
Phone
(701) 271-6383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 117 ND Primary

Addresses

Primary practice location

301 NP Avenue
Fargo, ND 58102

Mailing address

301 NP Avenue
Fargo, ND 58102
Phone (701) 271-1489

Other identifiers 2

IdentifierTypeStateIssuer
707614200MedicaidMN
1456278MedicaidND

Other names 1

  • Family HealthCare Pharmacy, NDSU Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D1008813Family Healthcare Pharmacy, Ndsu301 NP Ave, Fargo, ND 58102Certificate of waiverSep 23, 2026

National Provider Directory

National Provider Directory
Tax ID family
North Dakota State University5 organizations share this tax ID, including this one
Part of
North Dakota State University

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1194805796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 NP AVENUE",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58102",
            "telephone_number": "701-271-1489",
            "fax_number": "701-271-3345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 NP AVENUE",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58102",
            "telephone_number": "701-271-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DAKOTA STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH DAKOTA STATE UNIVERSITY",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "IVERSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "701-271-6383",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "ND",
            "license": "117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "707614200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1456278",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family HealthCare Pharmacy, NDSU",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family HealthCare Pharmacy, NDSU",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.