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General NPI Number Information
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NPI Number | 1194805796
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Entity Type | Organization
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Legal Business Name | NORTH DAKOTA STATE UNIVERSITY
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 301 NP AVENUE
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City | FARGO
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State | ND
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Zip | 58102
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Country | US
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Telephone | 701-271-1489
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Fax |
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Provider Business Mailing Address
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Address Line | 301 NP AVENUE
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City | FARGO
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State | ND
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Zip | 58102
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Country | US
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Telephone | 701-271-1489
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Fax | 701-271-3345
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JENNIFER IVERSON
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Credential | RPH
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Telephone | 701-271-6383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 117
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License Number State | ND
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