Healthcare Provider Details

I. General information

NPI: 1104748375
Provider Name (Legal Business Name): CHEYENNE ELIZABETH GILLESPIE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 OHMER ST
BOTTINEAU ND
58318-1059
US

IV. Provider business mailing address

108 BENNETT ST APT 4
BOTTINEAU ND
58318-1039
US

V. Phone/Fax

Practice location:
  • Phone: 701-228-2220
  • Fax: 701-228-5827
Mailing address:
  • Phone: 701-228-2220
  • Fax: 701-228-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6765
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: