Provider Demographics
NPI:1770013286
Name:FARGO, EMILY (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FARGO
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 EAST WASHINGTON STREET
Mailing Address - Street 2:MEDICAL OFFICE BUILDING - SOUTH, SUITE 1
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:970 EAST WASHINGTON STREET
Practice Address - Street 2:MEDICAL OFFICE BUILDING - SOUTH, SUITE 1
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-721-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450490183500000X
OH03338071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist