Healthcare Provider Details

I. General information

NPI: 1811445976
Provider Name (Legal Business Name): ROXANNE REYNE MCLEAN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
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

PO BOX 56
HANNAH ND
58239-0056
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2015
  • Fax:
Mailing address:
  • Phone: 701-283-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4429
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: