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General NPI Number Information
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NPI Number | 1992624043
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Entity Type | Individual
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Provider Name | ALEXIS KETCHAM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 1406 6TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1900
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Country | US
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Telephone | 320-251-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 15TH ST N APT 2
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1803
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Country | US
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Telephone |
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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 | 127372
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7346
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License Number State | SD
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