Provider Demographics
NPI:1457440430
Name:TRIEPKE, TANA NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TANA
Middle Name:NICOLE
Last Name:TRIEPKE
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 1:2228 12TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-8610
Mailing Address - Country:US
Mailing Address - Phone:701-662-5385
Mailing Address - Fax:
Practice Address - Street 1:3883 74TH AVE NE
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335
Practice Address - Country:US
Practice Address - Phone:701-766-1612
Practice Address - Fax:701-766-1625
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist