MEDICARE: DAWN LYNN PRUITT PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4670	ND

General Provider Information

NPI Number	:	1043351042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN LYNN PRUITT PHARM.D

Provider Business Mailing Address
First Line	:	446 18TH ST W
Second Line	:	SUITE 2
City	:	DICKINSON
State	:	ND
Zip	:	58601-3017
Country	:	US
Telephone Number	:	701-225-4434
Fax Number	:	701-225-0013

Provider Business Practice Location Address
First Line	:	446 18TH ST W
Second Line	:	SUITE 2
City	:	DICKINSON
State	:	ND
Zip	:	58601-3017
Country	:	US
Telephone Number	:	701-225-4434
Fax Number	:	701-225-0013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	07/10/2009

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