Healthcare Provider Details

I. General information

NPI: 1457440430
Provider Name (Legal Business Name): TANA NICOLE TRIEPKE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 74TH AVE NE
FORT TOTTEN ND
58335
US

IV. Provider business mailing address

2228 12TH AVE SW
DEVILS LAKE ND
58301-8610
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-1612
  • Fax: 701-766-1625
Mailing address:
  • Phone: 701-662-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5019
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: