Healthcare Provider Details

I. General information

NPI: 1114430584
Provider Name (Legal Business Name): LORI ANNE KREKLAU RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COLLEGE DR S
DEVILS LAKE ND
58301-3501
US

IV. Provider business mailing address

8265 89TH AVE NE
ALSEN ND
58311-9271
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2015
  • Fax: 701-662-2055
Mailing address:
  • Phone: 701-682-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH4022
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: