Healthcare Provider Details

I. General information

NPI: 1477982932
Provider Name (Legal Business Name): CARLA KIMBERLY DULETSKI PHARM.D.,RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 W VILLARD ST #1
DICKINSON ND
58601-4651
US

IV. Provider business mailing address

2615 FAIRWAY ST
DICKINSON ND
58601-2590
US

V. Phone/Fax

Practice location:
  • Phone: 701-227-8265
  • Fax:
Mailing address:
  • Phone: 701-483-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5652
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18744
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH5626
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: