Provider Demographics
NPI:1437208006
Name:FETTIG, ALLAN ROBERT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:ROBERT
Last Name:FETTIG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2436
Mailing Address - Country:US
Mailing Address - Phone:320-759-5694
Mailing Address - Fax:
Practice Address - Street 1:1209 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2436
Practice Address - Country:US
Practice Address - Phone:320-759-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist