Provider Demographics
NPI:1891901849
Name:CHURCHILL, PATRICIA M (R PH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3602
Mailing Address - Country:US
Mailing Address - Phone:701-255-1024
Mailing Address - Fax:
Practice Address - Street 1:103 W AVENUE B
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3602
Practice Address - Country:US
Practice Address - Phone:701-255-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist