MEDICARE: MR. NICHOLAS CRAIG FINNESGARD 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	121269	MN

General Provider Information

NPI Number	:	1457778102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS CRAIG FINNESGARD PHARM D

Provider Business Mailing Address
First Line	:	808 WASHINGTON AVE
Second Line	:	STE 29
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3033
Country	:	US
Telephone Number	:	218-847-9248
Fax Number	:	218-847-8874

Provider Business Practice Location Address
First Line	:	808 WASHINGTON AVE
Second Line	:	STE 29
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3033
Country	:	US
Telephone Number	:	218-847-9248
Fax Number	:	218-847-8874

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

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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