Provider Demographics
NPI:1558400598
Name:COLLETTE-GJORVEN, DOROTHY KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:KAY
Last Name:COLLETTE-GJORVEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3525
Mailing Address - Country:US
Mailing Address - Phone:701-572-6601
Mailing Address - Fax:
Practice Address - Street 1:MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ND
Practice Address - Zip Code:58853
Practice Address - Country:US
Practice Address - Phone:701-572-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist