Organization Active NPI

Killdeer Pharmacy Inc.

  • Community/Retail Pharmacy
  • Killdeer, ND
National Provider Identifier
1508972936
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
58 Issued in ND
Legal business name
KILLDEER PHARMACY INC.
Practice address
220 4TH Ave SW Ste B
Killdeer, ND 58640-8500
Phone
(701) 764-5093
Fax
(701) 764-5094
NPI assigned
Aug 21, 2006
Last updated
Feb 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

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

Authorized official

Name
Mr. Jody A Doe, RPHNPI 1922124833
Title
Owner
Phone
(701) 764-5093

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 58 ND Primary

Addresses

Primary practice location

220 4TH Ave SW Ste B
Killdeer, ND 58640-8500

Mailing address

220 4TH Ave SW Ste B
Killdeer, ND 58640-8500
Phone (701) 764-5093

Other identifiers 2

IdentifierTypeStateIssuer
3503744OtherNDNCPDP NUMBER
21196MedicaidND

National Provider Directory

National Provider Directory

Locations

220 4th Ave SW
Ste B
Killdeer, ND 58640
Phone (701) 764-5093

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771459200000",
    "number": "1508972936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 4TH AVE SW STE B",
            "city": "KILLDEER",
            "state": "ND",
            "postal_code": "586408500",
            "telephone_number": "701-764-5093",
            "fax_number": "701-764-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 4TH AVE SW STE B",
            "city": "KILLDEER",
            "state": "ND",
            "postal_code": "586408500",
            "telephone_number": "701-764-5093",
            "fax_number": "701-764-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILLDEER PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A",
        "authorized_official_last_name": "DOE",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-764-5093",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ND",
            "license": "58",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "3503744",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21196",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Killdeer, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2026; 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.