Provider Demographics
NPI:1427029735
Name:NORTH, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1644 HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MN
Practice Address - Zip Code:55055-1616
Practice Address - Country:US
Practice Address - Phone:651-459-9553
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111655-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist