Healthcare Provider Details

I. General information

NPI: 1215457338
Provider Name (Legal Business Name): KIRSTIN M GRAMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 1ST ST
DULUTH MN
55805-1901
US

IV. Provider business mailing address

1702 UNIVERSITY DR S MEDICAL STAFF SERVICES SSC
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-2151
  • Fax:
Mailing address:
  • Phone: 701-364-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPENDING
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: