MEDICARE: JADEY RISOVI

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	RPH6425	ND

General Provider Information

NPI Number	:	1598490385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADEY RISOVI

Provider Business Mailing Address
First Line	:	2475 32ND AVE S STE 1
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3606
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	:	07/18/2022
Last Update Date	:	12/06/2024

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Directions to “ JADEY RISOVI ” Practice Location

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