Healthcare Provider Details

I. General information

NPI: 1184888919
Provider Name (Legal Business Name): COLLEGE OF PHARMACY, NURSING, AND ALLIED SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 12TH AVE N
FARGO ND
58102-3400
US

IV. Provider business mailing address

1301 12TH AVE N
FARGO ND
58105-5055
US

V. Phone/Fax

Practice location:
  • Phone: 701-231-7609
  • Fax: 701-231-7606
Mailing address:
  • Phone: 701-231-6469
  • Fax: 701-231-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number166
License Number StateND

VIII. Authorized Official

Name: DR. CHARLES DEAN PETERSON
Title or Position: DEAN
Credential: PHARM.D.
Phone: 701-231-7609