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Individual

RICKY L DETWILLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
R.PH.

Contact information

Practice address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-6926
(701) 530-6907
Mailing address
1900 HARBOR DR, BISMARCK, ND 58504-8976
(701) 530-6926
(701) 530-6907

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3604
ND

Other

Enumeration date
01/23/2007
Last updated
01/15/2008
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