Healthcare Provider Details

I. General information

NPI: 1982826756
Provider Name (Legal Business Name): INTEGRATED HEALTH MARKETING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 26TH AVE S STE 136A
FARGO ND
58104-8975
US

IV. Provider business mailing address

5675 26TH AVE S STE 136A
FARGO ND
58104-8975
US

V. Phone/Fax

Practice location:
  • Phone: 701-373-0685
  • Fax: 701-373-0686
Mailing address:
  • Phone: 701-373-0685
  • Fax: 701-373-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR762
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATHAN SEIP
Title or Position: CHIEF MANAGER
Credential:
Phone: 218-640-2722