Healthcare Provider Details

I. General information

NPI: 1790762318
Provider Name (Legal Business Name): UNIVERSITY OF NORTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 2ND AVE N STOP 9038 MCCANNEL HALL RM 100
GRAND FORKS ND
58202-9038
US

IV. Provider business mailing address

MCCANNEL HALL RM 100 2891 2ND AVE N STOP 9038
GRAND FORKS ND
58202
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-3965
  • Fax: 701-777-6129
Mailing address:
  • Phone: 701-777-3965
  • Fax: 701-777-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number116
License Number StateND

VIII. Authorized Official

Name: COLLEEN CARLSON
Title or Position: PHARMACIST IN CHRGE
Credential: RPH
Phone: 701-777-3965