NPIMap

Organization Active NPI

Prescription Center Pharmacy Inc.

  • Clinic Pharmacy
  • Fargo, ND
National Provider Identifier
1639254113
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
02 Issued in ND
Legal business name
PRESCRIPTION CENTER PHARMACY INC.
Practice address
2701 13TH Ave S
Fargo, ND 58103-3602
Phone
(701) 234-3630
Fax
(701) 234-3631
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

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

Authorized official

Name
Jeffrey Douglas Jacobson
Title
President
Phone
(701) 234-9912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 02 ND Primary

Addresses

Primary practice location

2701 13TH Ave S
Fargo, ND 58103-3602

Mailing address

2701 13TH Ave S
Fargo, ND 58103-3602
Phone (701) 234-3630

Other identifiers 1

IdentifierTypeStateIssuer
20829MedicaidND

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1639254113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033602",
            "telephone_number": "701-234-3630",
            "fax_number": "701-234-3631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033602",
            "telephone_number": "701-234-3630",
            "fax_number": "701-234-3631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCRIPTION CENTER PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-234-9912"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "ND",
            "license": "02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20829",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jan 28, 2021; 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.