Healthcare Provider Details

I. General information

NPI: 1902971781
Provider Name (Legal Business Name): CARLA JEANNE AIPPERSPACH PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 S. CENTENNIAL ST BOX 217
WISHEK ND
58495
US

IV. Provider business mailing address

8230 41ST AVE SE
WISHEK ND
58495-9594
US

V. Phone/Fax

Practice location:
  • Phone: 701-452-2368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3972
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: