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General NPI Number Information
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NPI Number | 1760603658
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Entity Type | Individual
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Provider Name | MARK E CEGLOWSKI RPH
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1301 15TH AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-3821
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Country | US
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Telephone | 701-774-7433
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Fax | 701-774-7688
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Provider Business Mailing Address
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Address Line | 2203 4TH AVE E
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City | WILLISTON
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State | ND
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Zip | 58801-6205
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Country | US
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Telephone | 701-572-1717
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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 | 4903
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License Number State | ND
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