Healthcare Provider Details

I. General information

NPI: 1760603658
Provider Name (Legal Business Name): MARK E CEGLOWSKI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 15TH AVE W
WILLISTON ND
58801-3821
US

IV. Provider business mailing address

2203 4TH AVE E
WILLISTON ND
58801-6205
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-7433
  • Fax: 701-774-7688
Mailing address:
  • Phone: 701-572-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4903
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: