Individual
IVAN LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
706 38TH ST N STE A, FARGO, ND 58102-2953
(888) 558-9941
Mailing address
706 38TH ST N STE A, FARGO, ND 58102-2953
(888) 558-9941
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH6054
ND
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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