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General NPI Number Information
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NPI Number | 1659625663
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Entity Type | Individual
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Provider Name | DR. BENJAMIN WOODROW FRITCHMAN
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Gender | Male
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 645 LAKE ST S
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City | LONG PRAIRIE
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State | MN
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Zip | 56347-1545
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Country | US
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Telephone | 320-732-2915
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 7TH AVE S APT 219
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City | SARTELL
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State | MN
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Zip | 56377-8916
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Country | US
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Telephone | 320-533-0205
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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 | 120044
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License Number State | MN
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