MEDICARE: DR. REBECCA LYNN FOCKEN 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	1180576	MN
2	183500000X	Pharmacist	4984	ND

General Provider Information

NPI Number	:	1245316157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA LYNN FOCKEN PHARM.D.

Provider Business Mailing Address
First Line	:	1401 ALBRECHT BLVD
Second Line	:	NDSU, SUDRO HALL, 118L
City	:	FARGO
State	:	ND
Zip	:	58105-5055
Country	:	US
Telephone Number	:	701-231-7477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 ALBRECHT BLVD
Second Line	:	NDSU, SUDRO HALL, 118L
City	:	FARGO
State	:	ND
Zip	:	58105-5055
Country	:	US
Telephone Number	:	701-231-7477
Fax Number	:

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/18/2008

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