Paul Jerome Fedor, RPH
Individual provider Active NPI Pharmacist · Becker, MN
NPI 1104976273 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104976273
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 115014-0 (MN)
- Practice address
- 12800 Rolling Ridge Rd
Becker, MN 55308-8838 - Phone
- (763) 261-7008
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- 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 |
|---|---|---|---|
| 115014-0 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 115014-0 | MN | Yes |
Addresses
Primary practice location
12800 Rolling Ridge Rd
Becker, MN 55308-8838
Mailing address
2019 Highview Dr
Sauk Rapids, MN 56379-2641
Phone (320) 252-2132
Other providers in Becker, MN
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.