Provider Demographics
NPI:1770634479
Name:FLETSCHOCK, BECKY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:FLETSCHOCK
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 1:202 AVE B E
Mailing Address - Street 2:
Mailing Address - City:ANAMOOSE
Mailing Address - State:ND
Mailing Address - Zip Code:58710
Mailing Address - Country:US
Mailing Address - Phone:701-465-3082
Mailing Address - Fax:
Practice Address - Street 1:CLINIC PHARMACY
Practice Address - Street 2:1001 7TH ST NE
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301
Practice Address - Country:US
Practice Address - Phone:701-662-4427
Practice Address - Fax:701-662-1816
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist