Provider Demographics
NPI:1538428610
Name:UNIVERSITY OF NORTH DAKOTA
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH DAKOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-751-9500
Mailing Address - Street 1:701 E ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4461
Mailing Address - Country:US
Mailing Address - Phone:701-751-6800
Mailing Address - Fax:701-751-6804
Practice Address - Street 1:701 E ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4461
Practice Address - Country:US
Practice Address - Phone:701-751-6800
Practice Address - Fax:701-751-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NDPHAR6803336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456172Medicaid
2135060OtherPK