NPIMap

Organization Active NPI

University of North Dakota

  • Clinic Pharmacy
  • Grand Forks, ND
National Provider Identifier
1790762318
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
116 Issued in ND
Legal business name
UNIVERSITY OF NORTH DAKOTA
Practice address
2891 2ND Ave N Stop 9038
McCannel Hall RM 100
Grand Forks, ND 58202-9038
Phone
(701) 777-3965
Fax
(701) 777-6129
NPI assigned
Dec 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Authorized official

Name
Colleen Carlson, RPH
Title
Pharmacist in Chrge
Phone
(701) 777-3965

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X 116 ND Primary

Addresses

Primary practice location

2891 2ND Ave N Stop 9038
McCannel Hall RM 100
Grand Forks, ND 58202-9038

Mailing address

McCannel Hall RM 100
2891 2ND Ave N Stop 9038
Grand Forks, ND 58202
Phone (701) 777-3965

Other identifiers 3

IdentifierTypeStateIssuer
2071244OtherPK
1170540MedicaidND
1740130MedicaidMN

Other names 1

  • UNIVERSITY OF NORTH DAKOTA STUDENT HEALTH PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Und Family Practice Cen14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

2891 2nd Ave N
Stop 9038
Grand Forks, ND 58202
Phone (701) 777-4500

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1790762318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MCCANNEL HALL RM 100",
            "address_2": "2891 2ND AVE N STOP 9038",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58202",
            "telephone_number": "701-777-3965",
            "fax_number": "701-777-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2891 2ND AVE N STOP 9038",
            "address_2": "MCCANNEL HALL RM 100",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582029038",
            "telephone_number": "701-777-3965",
            "fax_number": "701-777-6129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF NORTH DAKOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "PHARMACIST IN CHRGE",
        "authorized_official_telephone_number": "701-777-3965",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "ND",
            "license": "116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2071244",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1170540",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740130",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNIVERSITY OF NORTH DAKOTA STUDENT HEALTH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; 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.