Individual
STACI L VAN VLEET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-9912
Mailing address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-9912
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4846
ND
Other
Enumeration date
09/24/2009
Last updated
09/24/2009
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