Provider Demographics
NPI:1376661165
Name:FOLEY, WANDA YVONNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:YVONNE
Last Name:FOLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 CRYSTAL CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-233-8248
Mailing Address - Fax:
Practice Address - Street 1:420 CENTER AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-233-1529
Practice Address - Fax:218-233-8917
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117151183500000X
ND4734183500000X
IN26019565A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist