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General NPI Number Information
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NPI Number | 1992345391
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Entity Type | Organization
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Legal Business Name | PROSPERITY HEALTH PHARMACY, PLLC
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 5180 PROSPERITY WAY S STE 106
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City | FARGO
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State | ND
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Zip | 58104-7568
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Country | US
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Telephone | 701-866-3920
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Fax |
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Provider Business Mailing Address
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Address Line | 5180 PROSPERITY WAY S STE 106
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City | FARGO
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State | ND
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Zip | 58104-7568
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Country | US
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Telephone | 701-951-7979
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Fax | 701-561-7139
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Authorized Official
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Title or Position | PHARMACIST
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Name | VIRGINIA HOWE
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Credential | PHARM.D.
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Telephone | 701-866-3920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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