Malory Bjella
Individual provider Active NPI Pharmacist · Fargo, ND
NPI 1780122135 · NPPES record last updated Feb 6, 2017
Key facts
- NPI
- 1780122135
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5245 (ND)
- Practice address
- 2425 13TH Ave S
Fargo, ND 58103-3749 - Phone
- (701) 232-4872
- NPI assigned
- Feb 6, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5245 | ND | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Drug Stores Delaware LLC | Past | Accepting new patients | |
| American Drug Stores Delaware LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5245 | ND | Yes |
Addresses
Primary practice location
2425 13TH Ave S
Fargo, ND 58103-3749
Mailing address
2425 13TH Ave S
Fargo, ND 58103-3749
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 Feb 6, 2017. 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.