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General NPI Number Information
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NPI Number | 1275822108
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Entity Type | Individual
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Provider Name | FARZANEH TAVASSOLI FORTIER RPH
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Gender | Female
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 2650 MT RUSHMORE RD
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City | RAPID CITY
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State | SD
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Zip | 57701
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Country | US
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Telephone | 605-718-4040
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Fax | 605-718-2650
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Provider Business Mailing Address
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Address Line | 2608 BADGER DR
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City | STURGIS
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State | SD
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Zip | 57785-2248
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Country | US
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Telephone | 605-720-9579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4616
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License Number State | SD
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