NPIMap

Organization Active NPI

North Dakota State University

  • Clinic Pharmacy
  • Fargo, ND
National Provider Identifier
1972000768
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
PHAR252 Issued in ND
Legal business name
NORTH DAKOTA STATE UNIVERSITY
Practice address
4025 9TH Ave S Ste D
Fargo, ND 58103-2101
Phone
(701) 551-2446
Fax
(701) 364-9938
NPI assigned
Apr 9, 2018
Organization subpart
Yes
Parent organization
NORTH DAKOTA STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Authorized official

Name
Nicole Daniel, RPHNPI 1699002600
Title
Pharmacist in Charge
Phone
(701) 551-2446

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
Clinic Pharmacy 3336C0002X PHAR252 ND Primary

Addresses

Primary practice location

4025 9TH Ave S Ste D
Fargo, ND 58103-2101

Mailing address

4025 9TH Ave S Ste D
Fargo, ND 58103-2101
Phone (701) 551-2446

Other identifiers 3

IdentifierTypeStateIssuer
1972000768MedicaidMN
PHAR252OtherNDSTATE PHARMACY LICENSE
1475078MedicaidND

Other names 1

  • Family HealthCare Pharmacy South Doing business as

National Provider Directory

National Provider Directory
Tax ID family
North Dakota State University5 organizations share this tax ID, including this one
Part of
North Dakota State University

Other organizations with this tax ID 4

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

Locations

4025 9th Ave S
Ste D
Fargo, ND 58103
Phone (701) 551-2446

301 Np Ave N
Fargo, ND 58102

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1972000768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 9TH AVE S STE D",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032101",
            "telephone_number": "701-551-2446",
            "fax_number": "701-364-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 9TH AVE S STE D",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032101",
            "telephone_number": "701-551-2446",
            "fax_number": "701-364-9938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DAKOTA STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH DAKOTA STATE UNIVERSITY",
        "enumeration_date": "2018-04-09",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "701-551-2446",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "ND",
            "license": "PHAR252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972000768",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY LICENSE",
            "identifier": "PHAR252",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1475078",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family HealthCare Pharmacy South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 20, 2025; 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.