Provider Demographics
NPI:1235140898
Name:ROLLA DRUG INC
Entity type:Organization
Organization Name:ROLLA DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCATEE
Authorized Official - Suffix:
Authorized Official - Credentials:REGPHARM
Authorized Official - Phone:701-477-3174
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0819
Mailing Address - Country:US
Mailing Address - Phone:701-477-3174
Mailing Address - Fax:701-477-3378
Practice Address - Street 1:117 MAIN AVE E
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-7124
Practice Address - Country:US
Practice Address - Phone:701-477-3174
Practice Address - Fax:701-477-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NDPHAR1203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2070917OtherPK
ND1455240Medicaid
0352220001Medicare NSC