Healthcare Provider Details

I. General information

NPI: 1578614632
Provider Name (Legal Business Name): DIANE M EHRLICH R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 7TH ST NE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

PO BOX 346
DEVILS LAKE ND
58301-0346
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-4427
  • Fax: 701-662-1816
Mailing address:
  • Phone: 701-351-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3405
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: