Provider Demographics
NPI:1639425176
Name:LUNDE, MARCUS K (RPH)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:K
Last Name:LUNDE
Suffix:
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 1:425 COLLEGE DR S
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3537
Mailing Address - Country:US
Mailing Address - Phone:701-662-6270
Mailing Address - Fax:701-662-6281
Practice Address - Street 1:425 COLLEGE DR S
Practice Address - Street 2:SUITE 10
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3537
Practice Address - Country:US
Practice Address - Phone:701-662-6270
Practice Address - Fax:701-662-6281
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND37141835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric