Healthcare Provider Details

I. General information

NPI: 1083126387
Provider Name (Legal Business Name): ASHLEY RAE HERTWIG-FRIELER PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S
FARGO ND
58103-5800
US

IV. Provider business mailing address

516 5TH ST
WYNDMERE ND
58081-4125
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-9912
  • Fax:
Mailing address:
  • Phone: 763-614-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6006
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: