Provider Demographics
NPI:1851839385
Name:MOTL, PATRICIA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MOTL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6658
Mailing Address - Country:US
Mailing Address - Phone:701-746-8643
Mailing Address - Fax:701-746-9302
Practice Address - Street 1:1950 32ND AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6658
Practice Address - Country:US
Practice Address - Phone:701-746-8643
Practice Address - Fax:701-746-9302
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18OtherPHARMACIST, ND RPH5673