MEDICARE: DR. TANA NICOLE TRIEPKE 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	5019	ND

General Provider Information

NPI Number	:	1457440430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANA NICOLE TRIEPKE PHARM.D.

Provider Business Mailing Address
First Line	:	2228 12TH AVE SW
Second Line	:
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-8610
Country	:	US
Telephone Number	:	701-662-5385
Fax Number	:

Provider Business Practice Location Address
First Line	:	3883 74TH AVE NE
Second Line	:
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335
Country	:	US
Telephone Number	:	701-766-1612
Fax Number	:	701-766-1625

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/03/2008

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