Healthcare Provider Details

I. General information

NPI: 1073806113
Provider Name (Legal Business Name): CARMEN A O'HALLORAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DIVISION AVE STE 100
GRAND FORKS ND
58201-4702
US

IV. Provider business mailing address

360 DIVISION AVE STE 100
GRAND FORKS ND
58201-4702
US

V. Phone/Fax

Practice location:
  • Phone: 701-757-4407
  • Fax: 701-757-4408
Mailing address:
  • Phone: 701-757-4407
  • Fax: 701-757-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number120758
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH5243
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: