Healthcare Provider Details

I. General information

NPI: 1821235235
Provider Name (Legal Business Name): MYRNA KAY ANDERSON R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E
MINOT ND
58701-4768
US

IV. Provider business mailing address

1823 15 1/2 ST SW
MINOT ND
58701-6184
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-7900
  • Fax: 701-857-7834
Mailing address:
  • Phone: 701-839-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3056
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number3056
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: