Corner Drug Store of Wahpeton Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

CORNER DRUG STORE OF WAHPETON INC

Doing business as

Corner Drug Store LTC

Practice address

619 Dakota Ave
Wahpeton, ND 58075-4325

Phone

(701) 642-6223

Fax

(701) 642-8839

NPI assigned

May 8, 2019

Last updated

May 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lucas Glarum, PHARM.DNPI 1447560297

Title

Pharmacist in Charge

Phone

(701) 642-6223

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Corner Drug Store LTC Doing business as

Electronic endpoints 1

Tax ID family

Corner Drug Store of Wahpeton Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Corner Drug Store of Wahpeton Inc

  • Community/Retail Pharmacy
  • Wahpeton, ND
  • NPI 1134345457
  NPD tax ID

Interoperability endpoints

• Direct secure messaging: cornerdrug@midconetwork.com

Practitioners 2

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.

• Lucas Bradley Glarum, PHARM.D

  • Pharmacist
  • Wahpeton, ND
  • NPI 1447560297
  NPD Authorized official
• Paul Donovan Folden, RPH

  • Pharmacist
  • Wahpeton, ND
  • NPI 1205826831
  NPD (past)

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1821653577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 DAKOTA AVE",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754325",
            "telephone_number": "701-642-6223",
            "fax_number": "701-642-8839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 DAKOTA AVE",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754325",
            "telephone_number": "701-642-6223",
            "fax_number": "701-642-8839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNER DRUG STORE OF WAHPETON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "GLARUM",
        "authorized_official_first_name": "LUCAS",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "701-642-6223",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20159",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "701260X",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3501803",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cornerdrug@midconetwork.com",
            "affiliation": "N",
            "endpointDescription": "Store Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "619 Dakota Ave",
            "city": "Wahpeton",
            "state": "ND",
            "country_code": "US",
            "postal_code": "580754325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Corner Drug Store LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian K Cooper, PA
• Jordan J Coplin, APRN, CNP
• Cheryl Core, LBSW
• Sean Core, PA-C
• Corner Drug Store of Wahpeton Inc
• Cottonwood Companion Care
• Dakota Clinic LTD (Day Surgery Wahpeton)
• Dakota Clinic LTD Wahpeton
• Dakota Clinic, LTD. (Dakota Clinic, LTD Wahpeton)
• Dakota Clinic, LTD. (Dakota Clinic, Ltd. - Wahpeton)

• Long Term Care Pharmacy in Wahpeton, ND
• Providers in Wahpeton, ND by specialty
• Long Term Care Pharmacy in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; 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.