Healthcare Provider Details

I. General information

NPI: 1306381512
Provider Name (Legal Business Name): MARNIE CARLSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HAMLINE ST
GRAND FORKS ND
58203-2819
US

IV. Provider business mailing address

233 RIVERS EDGE DR
GRAND FORKS ND
58201-8074
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6870
  • Fax:
Mailing address:
  • Phone: 218-779-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4534
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: