MEDICARE: MATTHEW VOLQUARDSEN

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	RPH6213	ND

General Provider Information

NPI Number	:	1285250464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW VOLQUARDSEN

Provider Business Mailing Address
First Line	:	3783 S 16TH ST APT 128
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-5333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 5TH ST NE STE 2
Second Line	:
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-2476
Country	:	US
Telephone Number	:	701-662-3022
Fax Number	:

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	06/23/2020

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