Individual
MR. RICHARD MICHAEL FAGERNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2420 W DIVISION ST, SAINT CLOUD, MN 56301-3926
(320) 253-5366
Mailing address
13316 311TH AVE, PRINCETON, MN 55371-3649
(320) 282-1080
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
113836
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113836
STATE LICENSE
MN
Enumeration date
04/06/2020
Last updated
04/06/2020
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