MEDICARE: GAYLE DELORA ZIEGLER 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	4127	ND
2	183500000X	Pharmacist	114252-7	MN

General Provider Information

NPI Number	:	1154440717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE DELORA ZIEGLER RPH

Provider Business Mailing Address
First Line	:	1720 UNIVERSITY DR S
Second Line	:	SANFORD PHAMACY SOUTH UNIVERSITY
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:	701-280-4467
Fax Number	:	701-280-4643

Provider Business Practice Location Address
First Line	:	1720 UNIVERSITY DR S
Second Line	:	SANFORD PHARMACY SOUTH UNIVERSITY
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:	701-280-4467
Fax Number	:	701-280-4643

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	10/18/2012

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