Provider Demographics
NPI:1083026322
Name:NYGAARD, ROSS DEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:DEAN
Last Name:NYGAARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 14TH ST NE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1628
Mailing Address - Country:US
Mailing Address - Phone:218-773-0611
Mailing Address - Fax:218-773-3532
Practice Address - Street 1:224 14TH ST NE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1628
Practice Address - Country:US
Practice Address - Phone:218-773-0611
Practice Address - Fax:218-773-3532
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist