Healthcare Provider Details

I. General information

NPI: 1063540086
Provider Name (Legal Business Name): SUSAN MARIE SCHNASE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY N
FARGO ND
58122-0001
US

IV. Provider business mailing address

3439 11TH ST S
FARGO ND
58104-6255
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2041
  • Fax:
Mailing address:
  • Phone: 701-234-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4338
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117206
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: