MEDICARE: DR. ALICIA LYNN FITZ PHARMD, RPH

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	5106	ND
2	183500000X	Pharmacist	116310	MN

General Provider Information

NPI Number	:	1134384100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA LYNN FITZ PHARMD, RPH

Provider Business Mailing Address
First Line	:	1707 CENTENNIAL BLVD
Second Line	:	NDSU STUDENT HEALTH CENTER PHARMACY
City	:	FARGO
State	:	ND
Zip	:	58105-5313
Country	:	US
Telephone Number	:	701-231-7332
Fax Number	:	701-231-6132

Provider Business Practice Location Address
First Line	:	1707 CENTENNIAL BLVD
Second Line	:	NDSU STUDENT HEALTH CENTER PHARMACY
City	:	FARGO
State	:	ND
Zip	:	58105-5313
Country	:	US
Telephone Number	:	701-231-7332
Fax Number	:	701-231-6132

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

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	07/18/2008

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