NPIMap

Organization Active NPI

Southtown Econodrug, Inc.

  • Community/Retail Pharmacy
  • Wahpeton, ND
National Provider Identifier
1710977897
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
152 Issued in ND
Legal business name
SOUTHTOWN ECONODRUG, INC.
Practice address
387 11TH St S
Wahpeton, ND 58075-4653
Phone
(701) 642-2336
Fax
(701) 642-1470
NPI assigned
Oct 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

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

Authorized official

Name
Paula L. McDonald, R.PHNPI 1306893052
Title
President
Phone
(701) 642-2336

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 152 ND Primary

Addresses

Primary practice location

387 11TH St S
Wahpeton, ND 58075-4653

Mailing address

387 11TH St S
Wahpeton, ND 58075-4653
Phone (701) 642-2336

Other identifiers 4

IdentifierTypeStateIssuer
21128MedicaidND
9167120MedicaidSD
091062700MedicaidMN
0776850001OtherNDMEDICARE PART B NSC#

National Provider Directory

National Provider Directory

Locations

387 11th St S
Wahpeton, ND 58075
Phone (701) 642-2336

Practitioners & affiliated clinicians

Practitioners 3

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": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1710977897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 11TH ST S",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754653",
            "telephone_number": "701-642-2336",
            "fax_number": "701-642-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 11TH ST S",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754653",
            "telephone_number": "701-642-2336",
            "fax_number": "701-642-1470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHTOWN ECONODRUG, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-642-2336",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ND",
            "license": "152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21128",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9167120",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091062700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B NSC#",
            "identifier": "0776850001",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wahpeton, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; 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.