Provider Demographics
NPI:1518023845
Name:ANDERSON, HOWARD CARROLL JR (RPH)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:CARROLL
Last Name:ANDERSON
Suffix:JR
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-0070
Mailing Address - Country:US
Mailing Address - Phone:701-448-2235
Mailing Address - Fax:701-328-9535
Practice Address - Street 1:218 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:ND
Practice Address - Zip Code:58575-0070
Practice Address - Country:US
Practice Address - Phone:701-448-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist