Healthcare Provider Details

I. General information

NPI: 1184700171
Provider Name (Legal Business Name): JAMES DUANE ENKERS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

1113 18 1/2 ST N
MOORHEAD MN
56560-1821
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax:
Mailing address:
  • Phone: 218-233-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number112471-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: