Healthcare Provider Details

I. General information

NPI: 1659856094
Provider Name (Legal Business Name): WILLIAM FRANK VOUK III PHARMD, BCGP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 N 19TH AVE E
DULUTH MN
55812-1127
US

IV. Provider business mailing address

1017 N 19TH AVE E
DULUTH MN
55812-1127
US

V. Phone/Fax

Practice location:
  • Phone: 320-630-8119
  • Fax: 856-494-1570
Mailing address:
  • Phone: 320-630-8119
  • Fax: 856-494-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number121740
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: