Individual
TAMARA RAE LIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1321 19TH AVE S, FARGO, ND 58104
(701) 232-2720
Mailing address
3026 36TH AVE S, FARGO, ND 58104-8844
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4604
ND
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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