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General NPI Number Information
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NPI Number | 1972000768
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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 | 04/09/2018
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 4025 9TH AVE S STE D
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City | FARGO
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State | ND
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Zip | 58103-2101
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Country | US
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Telephone | 701-551-2446
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Fax | 701-364-9938
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Provider Business Mailing Address
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Address Line | 4025 9TH AVE S STE D
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City | FARGO
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State | ND
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Zip | 58103-2101
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Country | US
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Telephone | 701-551-2446
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Fax | 701-364-9938
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | NICOLE DANIEL
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Credential | RPH
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Telephone | 701-551-2446
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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 | PHAR252
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License Number State | ND
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