Vicki L Brodsho, RPH
Individual provider Active NPI Pharmacist · Fargo, ND
NPI 1013120880 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1013120880
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 3909 (ND)
- Practice address
- MC Box #366
Fargo, ND 58107-9983 - Phone
- (701) 280-4468
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3909 | ND | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 3909 | ND | Yes |
Addresses
Primary practice location
MC Box #366
Fargo, ND 58107-9983
Mailing address
4527 4TH St S
Moorhead, MN 56560-6745
Phone (701) 306-5883
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.