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NPI Code Detail

MEDICARE: DARREN GAROLD MACK PHARM D

MEDICARE: DARREN GAROLD MACK 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
1183500000XPharmacist116436MN

General Provider Information

NPI Number : 1356949028
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARREN GAROLD MACK PHARM D
Provider Business Mailing Address
First Line : 703 BROADWAY AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-2114
Country : US
Telephone Number : 218-234-7942
Fax Number :
Provider Business Practice Location Address
First Line : 1583 HIGHWAY 10 W
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-2232
Country : US
Telephone Number : 218-847-7225
Fax Number : 218-847-8307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2020
Last Update Date : 10/14/2020

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