MEDICARE: DR. MELISSA LYN WENTZ OPSAHL PHARMD, NCPS

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	4480	ND
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	4480	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447243118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA LYN WENTZ OPSAHL PHARMD, NCPS

Provider Business Mailing Address
First Line	:	40520 COUNTY HIGHWAY 34
Second Line	:
City	:	OGEMA
State	:	MN
Zip	:	56569-9612
Country	:	US
Telephone Number	:	218-983-6375
Fax Number	:	218-983-6384

Provider Business Practice Location Address
First Line	:	40520 COUNTY HIGHWAY 34
Second Line	:
City	:	OGEMA
State	:	MN
Zip	:	56569-9612
Country	:	US
Telephone Number	:	218-983-6375
Fax Number	:	218-983-6384

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	04/29/2011

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