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NPI Code Detail

MEDICARE: BRITTANY FONDAKOWSKI

MEDICARE:   BRITTANY  FONDAKOWSKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist123452MN

General Provider Information

NPI Number : 1760093801
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY FONDAKOWSKI
Provider Business Mailing Address
First Line : 985 GENEVA AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-7409
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 985 GENEVA AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-7409
Country : US
Telephone Number : 651-731-8480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2020
Last Update Date : 08/12/2020

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Directions to “ BRITTANY FONDAKOWSKI ” Practice Location

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