Healthcare Provider Details

I. General information

NPI: 1831796465
Provider Name (Legal Business Name): JOELLEN M MCGAUVRAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 BROADWAY ST
THOMPSON ND
58278-4312
US

IV. Provider business mailing address

526 BROADWAY ST
THOMPSON ND
58278-4312
US

V. Phone/Fax

Practice location:
  • Phone: 218-779-6956
  • Fax:
Mailing address:
  • Phone: 218-779-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH4464
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: