Provider Demographics
NPI:1356313019
Name:BOHMER, DANIEL FREDERICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:FREDERICK
Last Name:BOHMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 30TH ST N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2561
Mailing Address - Country:US
Mailing Address - Phone:701-388-5547
Mailing Address - Fax:
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8143
Practice Address - Fax:701-364-8157
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4495183500000X
MN115414-6183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115414-6OtherPHARMACIST LICENSE
ND4495OtherPHARMACIST LICENSE