NPIMap

Organization Active NPI

White Drug Co of Jamestown Inc

Doing business as White Drug #57

  • Community/Retail Pharmacy
  • Maddock, ND
National Provider Identifier
1205926144
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHAR218 Issued in ND
Legal business name
WHITE DRUG CO OF JAMESTOWN INC
Doing business as
White Drug #57
Practice address
108 Central Ave N
Maddock, ND 58348-7204
Phone
(701) 670-1027
Fax
(877) 201-5332
NPI assigned
Oct 13, 2006
Last updated
Jul 31, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

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

Authorized official

Name
Anne Brader
Title
Cfo
Phone
(763) 513-4300

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHAR218 ND Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

108 Central Ave N
Maddock, ND 58348-7204

Mailing address

6701 Evenstad Dr N Ste 100
Maple Grove, MN 55369-6013
Phone (763) 513-4300

Other identifiers 2

IdentifierTypeStateIssuer
2071503OtherPK
1455900 DMEMedicaidND

Other names 1

  • WHITE DRUG #57 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785456000000",
    "number": "1205926144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 EVENSTAD DR N STE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696013",
            "telephone_number": "763-513-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CENTRAL AVE N",
            "city": "MADDOCK",
            "state": "ND",
            "postal_code": "583487204",
            "telephone_number": "701-670-1027",
            "fax_number": "877-201-5332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE DRUG CO OF JAMESTOWN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A",
        "authorized_official_last_name": "BRADER",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "763-513-4300"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ND",
            "license": "PHAR218",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2071503",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455900 DME",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WHITE DRUG #57",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WHITE DRUG #57",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maddock, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.