Healthcare Provider Details

I. General information

NPI: 1639223944
Provider Name (Legal Business Name): NATALIE LAYNE KOCH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

900 E BROADWAY AVE PO BOX 5510
BISMARCK ND
58501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-6890
  • Fax: 701-530-6891
Mailing address:
  • Phone: 701-530-6890
  • Fax: 701-530-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5064
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: