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General NPI Number Information
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NPI Number | 1720430564
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Entity Type | Individual
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Provider Name | TARA MICHELLE DAMMER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 706 38TH ST N STE A
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City | FARGO
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State | ND
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Zip | 58102-2953
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Country | US
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Telephone | 701-893-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 605 33RD AVE W APT 105
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City | WEST FARGO
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State | ND
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Zip | 58078-7881
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Country | US
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Telephone | 507-327-1515
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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 | RPH5863
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License Number State | ND
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