Organization
LIFESCRIPT PHARMACY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMONNE COIMBRA FONSECA RPH (OWNER)
(832) 549-3935
Entity
Organization
Contact information
Practice address
5670 38TH AVE S UNIT A, FARGO, ND 58104-9051
(701) 205-4545
(701) 205-0305
Mailing address
5670 38TH AVE S UNIT A, FARGO, ND 58104-9051
(701) 205-4545
(701) 205-0305
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHAR567
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1474535
—
ND
Enumeration date
09/23/2017
Last updated
01/30/2023
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